V.F.Snegirev Archives of Obstetrics and Gynecology

This systematic review aims to summarize current evidence on vitamin deficiencies in pregnant women, their clinical consequences, and approaches to nutritional status correction during gestation. Given the increasing prevalence of hypovitaminosis among pregnant women, particularly deficiencies of folic acid, vitamin D, and vitamin B12, the clinical importance of early diagnosis and individualized therapy is growing. The article analyzes studies published over the past 5 years by Russian and international authors, including randomized controlled trials, meta-analyses, cohort studies, and international clinical guidelines. Key micronutrients, their effects on the course of pregnancy, maternal and fetal outcomes, and factors contributing to impaired vitamin metabolism, including genetic polymorphisms (MTHFR, VDR, TCN2), were evaluated. The review presents approaches to laboratory diagnosis of vitamin deficiencies, principles of rational dietary therapy, and the use of vitamin–mineral supplements, as well as the potential of personalized nutritional correction. The need for incorporating vitamin status assessment into preconception care and antenatal management algorithms for women at risk is substantiated. The findings of this review emphasize the role of nutritional support as an essential component in the prevention of obstetric and perinatal conditions.

Chronic endometritis is one of the most significant and relevant challenges in reproductive medicine. This disease is associated with reduced pregnancy rates and an increased risk of spontaneous miscarriage and implantation failure in in vitro fertilization. Chronic endometritis is generally asymptomatic, which hiders timely diagnosis and treatment. This review summarizes current knowledge on the pathogenetic mechanisms, diagnostic capabilities, and treatment strategies for chronic endometritis, as well as their impact on reproductive outcomes. The analysis was based on data from 27 publications for 2021–2025 retrieved from international and Russian databases, encompassing meta-analyses, systematic reviews, and original clinical studies. The leading pathogenetic factors of chronic endometritis include microbial dysbiosis characterized by polymicrobial associations, neutrophil hyperactivation with the formation of neutrophil extracellular traps, cytokine imbalance, and activation of the USF2/TREM1 and miR-92b/PTEN signaling pathways. These alterations impair endometrial receptivity and hinder successful embryo implantation. Although a histological examination identifying CD138+ plasma cells remains the diagnostic gold standard, variability in threshold values complicates interpretation. Diagnostic evaluation is further complemented by hysteroscopy and promising noninvasive methods, including artificial intelligence-based analysis of hysteroscopic images and serum biomarker assessment. Antibiotic therapy remains the mainstay of treatment, though its effectiveness is undermined by rising antimicrobial resistance. Modern therapeutic approaches involve the use of recombinant type III collagen and antifibrotic therapy, which improve endometrial structure and receptivity, increasing pregnancy rates up to 73.9%. This review highlights the need for standardization of diagnostic algorithms, integration of molecular technologies, and adoption of combined therapeutic regimens to enhance management efficacy in chronic endometritis and improve reproductive outcomes.

Since its emergence in the 1980s, three-dimensional (3D) printing has become a representative manufacturing assist technology. It was first developed for rapid prototyping and is widely used in a variety of fields. Since the early 2000s, 3D bioprinting using biological materials such as cells and biomolecules has been successfully applied in tissue engineering to directly create living structures. Over the past several decades, advances in three-dimensional (3D) printing technologies and the development of specialized biomaterials have facilitated the precise fabrication of biological components and complex 3D shapes.

In obstetrics and gynecology, pessaries are increasingly used for stress urinary incontinence, pelvic organ prolapse, and cervical insufficiency. Commercially available pessaries come in a variety of sizes, following a “one size fits all” approach that fails to take into account the unique anatomical characteristics of each woman. The effectiveness of these pessaries is limited by poor fit and the lack of easy adjustment.

The aim of this study was to analyze literature on the feasibility of individualized pessary selection for stress urinary incontinence, рelvic organ prolapse and cervical insufficiency using 3D printing. We analyzed Russian and international publications in the PubMed, ScienceDirect, Elseiver, e-library databases, covering searches from 2015 to 2025.

BACKGROUND: Investigation of the impact of gestational age and the severity of Coronavirus Disease 2019 (COVID-19) on pregnancy outcomes is of particular importance in the context of the continuing relevance of this issue, as well as for the development of preventive strategies and therapeutic approaches aimed at reducing adverse maternal and fetal outcomes.

AIM: To evaluate perinatal outcomes in pregnant women who developed COVID-19 at different gestational ages and with varying degrees of disease severity.

METHODS: Perinatal outcomes were analyzed in pregnant women from three clinical groups: group 1, patients who developed COVID-19 during the first trimester (n = 119); group 2, patients infected during the second trimester (n = 121); group 3, patients infected during the third trimester of pregnancy (n = 120). Each clinical group was further divided into three subgroups according to the severity of COVID-19 (mild, moderate, and severe). Statistical analysis of the clinical data was performed using StatSoft software (Russia). Differences were considered statistically significant at p < 0.05.

RESULTS: The analysis showed that severe SARS-CoV-2 infection occurring in the first trimester of gestation contributes to pregnancy termination in more than 50% of clinical cases. At the same time, patients who had mild COVID-19 in early gestation significantly more frequently delivered infants with normal birth weight and favorable early neonatal adaptation compared with those born to mothers with moderate or severe COVID-19. SARS-CoV-2 infection during the second trimester identified pregnant women as a high-risk group for adverse perinatal outcomes, including fetal growth restriction, and increased the likelihood of complicated early neonatal adaptation. In pregnant women who developed COVID-19 during the third trimester, a high risk of acute fetal hypoxia and abdominal delivery was observed, not only for obstetric indications but also due to a more severe COVID-19 course. The higher rate of preterm birth among infants born to mothers with severe COVID-19 during the second and third trimesters was associated with earlier medically indicated delivery and with pathological maternal changes caused by infection-related hypoxia.

CONCLUSION: The study demonstrated that the distribution and frequency of perinatal complications depend on both the gestational age and the severity of COVID-19.

BACKGROUND: Early postpartum hemorrhage is a life-threatening complication that requires emergency care and a multidisciplinary approach. In addition to the main etiological causes of hemorrhage (the 4T concept), the influence of other factors has been identified, the study of which allows for the development of predictive scoring systems, differentiated preventive strategies, and minimization of the risk of early postpartum hemorrhage.

AIM: To identify factors influencing the development of early postpartum hemorrhage, stratify the obtained data, and develop a risk assessment scoring system for this complication.

METHODS: A retrospective case–control study was conducted. The main group (n = 219) included women whose deliveries were complicated by early postpartum hemorrhage, whereas the control group (n = 219) consisted of women without postpartum hemorrhage. A list of potential factors determining the risk of postpartum hemorrhage (comprising 38 parameters in total) was compiled. The effect of each parameter on hemorrhage risk was assessed using odds ratios with 95% confidence intervals, p values for statistical significance, and the Student t test. Logistic regression analysis was used to stratify the impact of predictors on the development of early postpartum hemorrhage.

RESULTS: Statistical analysis identified 25 factors that significantly increased the risk of postpartum hemorrhage. Oligohydramnios at the time of hospitalization increased the risk of postpartum hemorrhage by 1.6 times, polyhydramnios by 1.7 times, premature rupture of membranes by 1.7 times, class I obesity by 1.9 times, class II obesity by 2.2 times, gestational diabetes mellitus by 2.0 times, and the presence of a uterine scar after cesarean delivery or myomectomy by 2.2 times. Using logistic regression analysis and odds ratio data, these predictors were successfully stratified and integrated into a unified scoring system for assessing the risk of early postpartum hemorrhage.

CONCLUSION: The proposed risk stratification score for postpartum hemorrhage serves as a clinical decision support tool in urgent settings, enabling rapid and objective assessment of early postpartum hemorrhage risk, timely implementation of preventive measures, and improvement of maternal outcomes.

This article presents a review of the etiology, pathogenesis, clinical manifestations, and diagnostic approaches to aortic coarctation, which accounts for approximately 6%–7% of all congenital heart defects and occurs in pregnancy with a frequency of about 1 case per 4500 deliveries. For a long time, pregnancy in women with aortic coarctation was considered extremely high risk, and pregnancy termination was often recommended. Pregnancy in women with unrepaired aortic coarctation is frequently associated with various complications, including uncontrolled hypertension, preeclampsia, hypertensive crisis, congestive heart failure, stroke, and aortic rupture or dissection.

At present, there are no clear guidelines or a unified approach to the management of pregnancy in women with aortic coarctation. Recent studies indicate that, with appropriate management, pregnancy may proceed without serious complications. The main reasons for hospitalization during pregnancy in these patients include heart failure, uncontrolled hypertension, and supraventricular arrhythmias. Therefore, strict blood pressure control appears to be a key component in the management of pregnant women with this condition. A clinical case describing pregnancy management and delivery in a patient with newly diagnosed aortic coarctation is also presented.

Surgical treatment of giant uterine fibroids with cervical localization represents one of the most challenging tasks in operative gynecology. The main difficulties are associated with distorted pelvic anatomy, limited space for manipulations, and a high risk of massive intraoperative bleeding, which necessitates the use of modern blood loss control techniques. Among these approaches, temporary endovascular balloon occlusion of the major pelvic vessels has proven to be a highly effective technique for minimizing hemorrhagic risk and ensuring the safety of radical surgery. This article presents a clinical case describing successful treatment of a 56-year-old woman with a giant uterine fibroid of a 20-week gestational size, cervical localization of the lesion, and severe comorbidities. The patient’s medical history was complicated by an episode of massive uterine bleeding in February 2024 that required emergency uterine artery embolization. Considering the patient’s age, fibroid size, complex localization, and comorbidity burden, a two-stage treatment strategy was chosen. During the first stage, preoperative preparation with a gonadotropin-releasing hormone agonist was carried out for three months to reduce fibroid volume. At the second stage, panhysterectomy was performed with prior temporary balloon occlusion of the common iliac arteries.

With temporary vascular occlusion, hysterectomy with bilateral adnexectomy was successfully completed. A critical outcome was minimal intraoperative blood loss of only 200 mL, which did not require blood transfusion. The arterial occlusion lasted 40 minutes, which prevented ischemic complications. This clinical case clearly demonstrates the effectiveness of temporary balloon occlusion of the major pelvic vessels as a key method for preventing massive intraoperative blood loss during hysterectomy for giant uterine fibroids with complex localization. The technique appears promising and may be considered a standard of care in similar clinical situations.