V.F.Snegirev Archives of Obstetrics and Gynecology
ISSN (print): 2313-8726, ISSN (online): 2687-1386 Founder: Joint Stock Company "Publishing house "Medicina", Limited Liability Company "Eco-Vector" Editor-in-Chief: prof. Elena A. Sosnova, MD, Dr. Sci. (Med.) Frequency / Access: 4 issues per year / Hybrid Included in: Higher Attestation Commission List, RISC
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Snegirev Archives of Obstetricsand Gynecology” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “V. F. Snegirev Archives of Obstetricsand Gynecology” (further-the Journal) in accordance with the conditions stated below. I. 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Extending the reproductive period in women: modern approaches and anti-aging therapy
The increase in life expectancy and the trend toward postponing first pregnancy have stimulated the search for effective methods to extend the reproductive period in women and to improve their quality of life. This review analyzes current understanding of the physiological and molecular processes underlying ovarian aging, as well as contemporary anti-aging strategies aimed at enhancing ovarian reserve and maintaining fertility. Particular attention is given to the role of oxidative stress, mitochondrial dysfunction, and epigenetic mechanisms, including DNA modifications, along with innovative therapeutic approaches. Specifically, platelet-rich plasma (PRP) therapy (intraovarian injection of platelet-rich plasma), the use of stem cells for ovarian tissue regeneration, senotherapy targeting the elimination of senescent cells, and the prospects of mitochondrial donation technology to improve oocyte quality are discussed. Clinical and experimental studies demonstrating the efficacy of these strategies in preserving reproductive potential are presented, highlighting new opportunities in infertility treatment, quality-of-life improvement, and enabling later motherhood. Limitations and future research directions in this rapidly evolving field are also discussed.
Potential applications of ambulatory blood pressure monitoring in obstetric practice
Blood pressure control plays an important role in pregnancy management, as blood pressure levels may fluctuate throughout the day for various reasons. To provide a rationale for prescribing pharmacotherapy and determining pregnancy management strategies, it is essential to obtain objective data on blood pressure changes. The aim of this review was to summarize the scientific data on the use of ambulatory blood pressure monitoring in obstetric practice. The review is based on an analysis of publications retrieved through a selective search in PubMed, Web of Science, Scopus, Google Scholar, and RSCI databases. Evidence shows that using ambulatory (daily) blood pressure monitoring in pregnant women enables the collection of accurate and reliable data on blood pressure changes, facilitates prediction of the development and course of preeclampsia, and helps prevent the unjustified use of antihypertensive drugs. At the same time, further research is needed to assess the economic feasibility of ambulatory blood pressure monitoring in obstetric practice, develop preventive treatment strategies for hypertension in pregnant women, and design devices that are as convenient as possible for patients.
Transmembrane receptor ROR1 as a therapeutic target in endometrial cancer
Endometrial cancer remains one of the most prevalent malignant neoplasms of the female reproductive system. Despite advancements in diagnostics and treatment, aggressive subtypes of the disease are characterized by high rates of metastasis, recurrence, and decreased overall survival, underscoring the need for novel therapeutic targets. One such promising molecular factor is the receptor tyrosine kinase-like orphan receptor 1 (ROR1), which is normally expressed predominantly in embryonic tissues but reactivates in various malignancies, including endometrial cancer. ROR1 plays a role in the activation of key signaling pathways such as PI3K/Akt/mTOR, MAPK, and Wnt/β-catenin, regulating processes like cell proliferation, apoptosis, invasion, and epithelial-mesenchymal transition. High ROR1 expression correlates with unfavorable clinicopathological features, including high tumor grade, advanced FIGO stages, and decreased overall survival. Moreover, ROR1 contributes to chemoresistance by activating anti-apoptotic Bcl-2 family proteins and supporting inflammatory microenvironment signaling. This article provides a comprehensive review of the molecular mechanisms involving ROR1, its role in oncogenesis and endometrial cancer progression, and its potential as both a prognostic biomarker and therapeutic target. Current approaches to targeted therapy are discussed, including the application of antibody–drug conjugates such as zilovertamab vedotin, and their prospects for clinical implementation. Given the significance of ROR1 in endometrial cancer pathogenesis, its inhibition may serve as the basis for personalized treatment strategies aimed at overcoming resistance and improving prognosis in patients with aggressive forms of endometrial cancer.
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Prevalence of PAI-1 (F2, F5, FGB) gene polymorphisms in women with obesity: impact on pregnancy outcomes
The coexistence of obesity and thrombophilic gene polymorphisms (PAI-1, F5, F2, FGB) in pregnant women significantly increases the risk of obstetric complications. Metabolic disturbances in obesity (hyperinsulinemia, elevated levels of proinflammatory cytokines) potentiate the expression of these genes, leading to pronounced hemostatic disorders such as hypercoagulation, hypofibrinolysis, and impaired placentation. Clinically, this manifests as higher rates of preeclampsia, fetal growth restriction, gestational diabetes, and venous thromboembolism. The impact of individual polymorphisms (particularly F2 and FGB) remains controversial and largely depends on the patient’s ethnic background and combinations with other genetic variants. For instance, PAI-1 4G/5G shows a consistent association with adverse outcomes in some populations, whereas isolated F5 Leiden polymorphism rarely correlates with placental complications without synergistic effects from PAI-1 or obesity. Addressing this issue requires personalized strategies. Anticoagulant therapy (low-molecular-weight heparins) is effective mainly in cases of high combined thrombotic risk, but additional control of metabolic disorders (weight reduction, correction of insulin resistance) is essential to manage placental insufficiency. Future research priorities include the development of ethnicity-adapted algorithms integrating combinatorial genetic profiles and biomarker changes.
New indicators of known markers in the early prediction of preeclampsia progression
Background: Preeclampsia is a multisystem complication affecting 2%–8% of pregnant women and makes a significant contribution to maternal and perinatal morbidity and mortality. Aim: To determine the predictive value levels of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and the sFlt-1/PlGF ratio in forecasting the progression of preeclampsia severity within two weeks. Methods: A prospective cohort study was conducted. It included 64 patients with singleton pregnancies complicated by elevated blood pressure (>140/90 mmHg) and/or proteinuria, who were admitted to City Clinical Hospital named after S.S. Yudin (Moscow) at 22–38 weeks of gestation. Venous blood samples were collected at admission to determine sFlt-1 and PlGF concentrations and the sFlt-1/PlGF ratio. Based on the clinical course and pregnancy outcome, patients were divided into two groups: group 1, 30 (54.5%) women with preeclampsia who experienced maternal deterioration and/or fetal compromise requiring early delivery; group 2, 25 (45.5%) women with stable preeclampsia whose pregnancies were successfully prolonged to term under treatment in accordance with clinical guidelines. Group 1 was further divided into two subgroups according to delivery timing: subgroup 1a, women who delivered within two weeks; subgroup 1b, women who delivered after more than two weeks. Results: The analysis showed statistically significant differences between the groups (p < 0.01 and p = 0.011 in sFlt-1 levels and the sFlt-1/PlGF ratio, respectively), whereas no statistically significant differences were found in PlGF levels (p = 0.076). Threshold values for sFlt-1 and the sFlt-1/PlGF ratio indicating high risk of preeclampsia that required early delivery were 30,297 pg/mL and 3030, respectively. In the next stage, threshold values predicting preeclampsia progression within two weeks were determined as 23,497.0 pg/mL for sFlt-1 and 977.7 for the sFlt-1/PlGF ratio. Conclusion: This study established threshold values of sFlt-1 and the sFlt-1/PlGF ratio, indicating a high risk of preeclampsia in patients with initial nonspecific symptoms. In addition, threshold values were identified that indicate a high probability of progression to severe preeclampsia requiring delivery within two weeks.
Comparative study of sexual function in women with radiation-induced vaginal stenosis before and after treatment
Background: One of the common complications following radical surgery and chemoradiotherapy of the pelvic organs is radiation-induced vaginal stenosis, which exerts a persistent negative impact on female sexual function and requires addressing the issue of providing assistance to women in this regard. Aim: The work aimed to evaluate sexual satisfaction in patients with radiation-induced vaginal stenosis using the Female Sexual Function Index before and after individually tailored treatment. Methods: The study included 25 women: 10 patients with radiation-induced vaginal stenosis treated with hyaluronic acid injections combined with dilator therapy (group 1); 5 patients who required surgical intervention—vaginal reconstruction with a Martius–Symmonds myocutaneous flap (group 2); and 10 women in the control group (group 3). Results: The main Female Sexual Function Index domains were assessed: desire, arousal, lubrication, orgasm, satisfaction, and pain. Before treatment, the total scores in group 1 and group 2 were lower compared with the control group, with the severity of sexual dysfunction corresponding to low scores. After treatment, all domains of sexual quality of life improved in group 1, with the highest scores recorded in arousal (5.13 ± 0.29) and satisfaction (4.52 ± 0.41) domains, followed by orgasm (5.00 ± 0.43), desire (4.80 ± 0.45), lubrication (4.80 ± 0.32), and pain (4.20 ± 0.39). After treatment, the satisfaction score in group 2 was the highest, 3.92 ± 0.65, and the orgasm score was 3.84 ± 0.44. The other domains showed the following values: lubrication, 3.48 ± 0.68; desire, 3.48 ± 0.97; arousal, 3.48 ± 1.01; pain, 3.04 ± 1.30. Conclusion: The findings may serve as an incentive for further research into the treatment of radiation-induced vaginal stenosis and, consequently, improving the sexual quality of life in women.
Application of thulium laser for endometrial polyp removal in women of reproductive age
Background: Endometrial polyps are a common gynecological condition, occurring in 10%–24% of women of reproductive age, which often leads to infertility and menstrual disorders. Bipolar resection is considered one of the effective methods of polyp removal; however, it is accompanied by significant pain and prolonged recovery. Among the more effective and less painful approaches, the use of the thulium laser is considered a promising option, having already proven successful in modern urological practice. Aim: To evaluate the efficacy and safety of thulium laser polypectomy in women of reproductive age. Methods: The study, which included 46 women with endometrial polyps (23 in each group), compared two methods of polypectomy: thulium laser and bipolar resection. The following parameters were taken into account: procedure duration, pain level, time to menstrual cycle recovery, recurrence rate, and acceptability. Results: Thulium laser treatment demonstrated shorter operation time (10.04 ± 0.97 min vs 13.86 ± 1.20 min), less pain, faster recovery of menstrual function (28.6 ± 2.9 days vs 34.65 ± 3.06 days), and a lower recurrence rate (8.69% vs 17.39%). Patient acceptability of the thulium laser was also higher (99.39% vs 92.39% at 1 month). Conclusion: The findings indicate the benefits of thulium laser in the treatment of endometrial polyps and highlight the need for further studies to assess its long-term outcomes.
Efficacy of contour-loop excision and conization of the cervix in high-grade squamous intraepithelial lesions
Background: At present, despite numerous excisional methods for the treatment of High-Grade Squamous Intraepithelial Lesion (HSIL), the rates of residual lesions and recurrences remain rather high, ranging from 30% to 50% regardless of the method chosen. Notably, up to 30% of women remain infected with human papillomavirus after surgical treatment. Therefore, the choice of the optimal excision technique for HSIL is still relevant, as it should reduce the incidence of residual lesions, disease recurrence, and human papillomavirus persistence. Aim: The work aimed to evaluate the efficacy of contour-loop excision (C-LETZ) and classical cervical conization in HSIL. Methods: In 2021–2023, at the Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, 66 patients with histologically confirmed HSIL were examined, treated, and followed up; classical cervical conization (group 1, n = 32) and contour-loop excision of the cervix using a wave-shaped C-LETZ cone (group 2, n = 34) were performed. Results: Positive endocervical resection margins were observed more frequently after classical cervical conization compared with C-LETZ (р < 0.001). Conization more often revealed endocervical crypt involvement at the apex of the excised cone (р = 0.03), as well as the presence of HSIL in endocervical curettage (р = 0.01). In group 1, 8% of women had intraepithelial lesions confined to the endocervical curettage with no involvement in the resected specimens, compared with 0% in group 2. Residual lesions in group 1 were detected in 6% (2/32) within one year of follow-up and in 12% (4/32) between one and two years. Disease recurrence after two years of follow-up was diagnosed in 18% of women (6/32). In group 2, residual lesions were identified in 3% (1/34) within one year and in 6% (2/34) between one and two years. Recurrence after two years was three times less frequent compared with group 1—in 6% of women (2/34); p = 0.01. Conclusion: Due to the wave-shaped structure of the C-LETZ loop, excision allows deeper capture of the endocervix, thereby increasing the volume of resected cervical canal tissue. This contributes to a twofold reduction in positive endocervical margins and human papillomavirus persistence, and a 1.5-fold reduction in residual crypt lesions compared with classical conization. Thus, deeper removal of endocervical tissue with C-LETZ reduces the risk of human papillomavirus persistence, residual lesions, and disease recurrence.
Features of lipid peroxidation and antioxidant system status in women after spontaneous miscarriage
Background: Among the complications of miscarriage, the most common are inflammatory conditions, which may be associated with oxidative stress and antioxidant deficiency—a universal mechanism in the development of many conditions, including gynecological diseases. Aim: The work aimed to investigate lipid peroxidation and antioxidant defense status in patients after first-trimester miscarriage during preventive anti-inflammatory therapy. Methods: A total of 146 women of reproductive age (26.8±2.8 years) were divided into three groups after miscarriage. Group 1 (n=48) received combined prophylaxis, which consisted of antibacterial therapy (metronidazole±azithromycin) and physiotherapy (magneto–infrared–laser therapy of the pelvic area); Group 2 (n=45) received only physiotherapy; Group 3 (n=53) received only antibacterial therapy. Vaginal microbiome analysis revealed normal and conditionally pathogenic microbiota. Levels of lipid peroxidation (malondialdehyde and diene conjugates) and antioxidant defense system markers (catalase and superoxide dismutase activity) were assessed in all patients and in 30 healthy women, both before treatment and two weeks after therapy. Results: Compared with healthy women, post-miscarriage patients had a 1.3-fold increase in malondialdehyde levels and a 1.2-fold increase in diene conjugates (p <0.05), as well as a 1.4-fold decrease in catalase and a 1.25-fold decrease in superoxide dismutase (p <0.05). The best outcomes were observed with combined antibacterial and physiotherapy treatment (no complications recorded). The rate of chronic salpingo-oophoritis exacerbation with physiotherapy alone and with antibacterial therapy alone was 4.4% and 5.3%, respectively (p >0.05). Conclusion: Recovery of the antioxidant system after miscarriage occurs faster with combined therapy including antibacterial drugs and magneto–infrared–laser therapy. This approach significantly reduces the incidence of inflammatory complications.
Managing a pregnancy with cervical insufficiency and fetal intraventricular hemorrhage: a case report
This article presents a clinical case of a pregnant woman with cervical insufficiency who underwent laparoscopic cerclage prior to pregnancy due to recurrent miscarriages. The patient had a history of four pregnancies with unfavorable outcomes. Considering the complicated obstetric history, laparoscopic correction of cervical insufficiency was recommended. The first trimester proceeded without complications. In the second trimester, an ultrasound revealed signs of fetal intraventricular hemorrhage on the right. Reverse transcription polymerase chain reaction of cervical canal swab showed parvovirus B19. A case conference was held, and the decision was made to keep the pregnancy. The progress was monitored using ultrasound and Doppler ultrasound. Owning to the fetus’ condition, the patient was referred to a federal medical institution for delivery and specialized, high-tech medical care. Follow-up ultrasounds and Doppler examinations of the fetus prior to delivery showed no negative changes related to intraventricular hemorrhage. The patient underwent an emergency cesarean section at the Perinatal Center of St. Petersburg State Pediatric Medical University at 38 weeks and 6 days of gestation.
Mediastinal large B-cell lymphoma and pregnancy: challenges in diagnosis and choice of rational medical management
A multigravida woman at term gestation was admitted to the obstetric hospital with complaints of dyspnea at rest and dry cough persisting for the past three months. On examination, signs of severe respiratory failure were evident. Chest computed tomography revealed a large mediastinal mass measuring 200 × 150 mm, compressing mediastinal structures and causing infiltrative changes in the lower lobe of the left lung. Taking into account the life-threatening condition of the pregnant woman and the high risk of a fatal outcome, an emergency delivery was performed simultaneously with a biopsy of the mass. Histological examination of the biopsy material confirmed the diagnosis of diffuse large B-cell lymphoma. In the postoperative period, immunochemotherapy according to the R-CHOP protocol was initiated, resulting in significant reduction in the size of the mass, perifocal edema, and compression of adjacent organs. Ultrasound and magnetic resonance imaging are considered the safest diagnostic modalities during pregnancy. However, it should be remembered that when maternal life is at risk, there are no absolute contraindications to any diagnostic procedures, including radiological imaging, at any gestational age. Modern scanning protocols and protective measures make it possible to minimize perinatal risks.
Abdominal pregnancy with live birth in the third trimester
Abdominal pregnancy is a rare form of ectopic pregnancy, accounting for 0.1% of all pregnancies. This condition is associated with unfavorable outcomes due to the difficulty of diagnosis and the lack of standardized management strategies. This article describes a case of abdominal pregnancy resulting in live birth. The patient had been under antenatal observation from the early stages of pregnancy. Routine ultrasound examinations performed at standard gestational ages described a developmental anomaly (bicornuate uterus) as well as signs of placenta previa. In accordance with clinical routing, the patient stayed in a tertiary obstetric hospital from week 33 of gestation. On day 7 of inpatient care, she complained of girdle-like, dull epigastric pain and nausea. Instrumental and clinical-laboratory assessment established an additional diagnosis of chronic pancreatitis in incomplete remission. The patient was transferred to a multidisciplinary regional clinical hospital. The next day, a follow-up obstetric ultrasound revealed a decrease in the amniotic fluid index to 0 mm. Considering the absolute oligohydramnios, complete placenta previa, and placenta accreta, urgent cesarean delivery was performed. Intraoperatively, the diagnosis of abdominal pregnancy was established. A live preterm female infant was delivered.