Vol 74, No 1 (2025)

This article provides a comprehensive historical overview of the development of classical obstetrics in Europe and Russia during the 19th century. The concept of classical originated in Europe in the early 19th century and became fundamental to the development of classical obstetrics. At that time, Ernst Bumm was the father of classical obstetrics in Western Europe, while in Russia, Eduard-Anton Y. Krassovsky became the leader and founder of scientific classical obstetrics. Krassovsky founded the first Russian Society of Obstetricians and Gynecologists in St. Petersburg (1886) and the Journal of Obstetrics and Women’s Diseases (1887). The article explores key problems currently faced by obstetrics, highlighting the high prevalence of surgical deliveries. The author emphasizes that pregnancy and childbirth are natural physiological processes that have evolved over centuries to meet the needs of human survival. Therefore, he advocates for promoting natural and high-quality childbirth. He also calls for aligning with global practices by implementing mandatory newborn resuscitation at weeks 24–25 of gestation, which would address various moral, ethical, economic, social, and legal concerns. Furthermore, the article underscores the importance of conducting scientific research with precision to eliminate risks for patients and provides a critical evaluation of certain treatment approaches for postpartum hemorrhage.

BACKGROUND: The increasing prevalence of uterine fibroids at the age of 20–35 years and late fertility intentions are modern trends in women’s lives. Combined hormonal contraceptives level out cyclic fluctuations of sex steroids in the natural menstrual cycle; can be used by patients with fibroid nodes for contraception; and have a protective effect on uterine fibroids. The literature does not provide comparative data on the use of multi- and monophasic combined hormonal contraceptives with ethinyl estradiol by patients with uterine fibroids.

AIM: The aim of this study was to assess the characteristics of fibroid nodes in dynamics in women using multiphasic and monophasic combined hormonal contraceptives.

MATERIALS AND METHODS: This study included 554 women. Prospective part of the research involved 118 patients with uterine fibroids without indications for surgical treatment: 54 patients used multiphasic (ethinyl estradiol and desogestrel) and monophasic (ethinyl estradiol and various gestagens) combined hormonal contraceptives, and 64 patients did not. Who underwent pelvic ultrasound examination three times over 12 months. Retrospective part of the research included analysis of in-person instrumental-clinical-anamnestic data obtained from 436 women (45 patients with fibroid nodes and 391 healthy individuals). Out of the 391 healthy participants, 297 ones used various combined hormonal contraceptives with ethinyl estradiol for 1–30 years, while the other 94 did not.

RESULTS: In women with uterine fibroids using various combined hormonal contraceptives with ethinyl estradiol (n = 94), no changes in the sizes of classification of International Federation of Gynaecology and Obstetrics (FIGO) types 3 to 6 fibroid nodes were observed (n = 124; 21.7 ± 2.8 vs. 21.5 ± 3.2 mm; p > 0.05). In patients with FIGO type 4 fibroid nodes using multiphasic combined hormonal contraceptives (n = 20), a decrease in the size of the nodes was registered after 12 months (n = 14; 15.7 ± 3.4 vs. 14.1 ± 2.7 mm; p < 0.05). In 17 (5.7%) healthy participants using combined hormonal contraceptives and in 15 (16.0%) patients without fibroid nodes who did not use these drugs, uterine fibroids were first diagnosed in the reproductive period.

CONCLUSIONS: The use of various combined hormonal contraceptives by patients with uterine fibroids did not lead to an increase in the size of FIGO types 3 to 6 fibroid nodes with an initial diameter of up to 22 mm. After 12 months, we noted a decrease in the size of F4 type fibroid nodes with an initial diameter of up to 16 mm for the women with uterine fibroids, who took multiphasic combined hormonal contraceptives. In women of reproductive age who used combined hormonal contraceptives for 1–30 years, uterine fibroids were first diagnosed 2.8 times less often than in patients who did not use these drugs.

BACKGROUND: Autophagy is essential for placenta formation and fetal brain development. Maternal hyperhomocysteinemia is a risk factor for pregnancy complications and may affect autophagy processes. However, the dynamics of autophagy markers are not studied enough so far.

AIM: The aim of this study was to assess the dynamics of key autophagy markers in the fetal brain and various parts of the placenta of rats throughout pregnancy under normal conditions and in the presence of maternal hyperhomocysteinemia.

MATERIALS AND METHODS: Pregnant Wistar rats were induced with hyperhomocysteinemia by chronic administration of L-methionine. Placental and fetal brain tissues were collected on days 14 and 20 of gestation. Levels of autophagy markers (Beclin-1; phosphatidylethanolamine conjugated form microtubule-associated protein 1A/1B light chain 3B (LC3B-II); lysosomal associated membrane protein 2 (LAMP-2)] were determined by Western blotting. Ultrastructural changes were examined using electron microscopy.

RESULTS: In the control group, by the end of pregnancy (gestational day 20) compared to gestational day 14, we observed an increase in LAMP-2 level in the maternal part of the placenta and a decrease in LC3B-II level in the fetal part of the placenta. In maternal hyperhomocysteinemia in the maternal part of the placenta, we found an increase in LAMP-2 level on gestational day 14 and in LC3B-II level from gestational day 14 to gestational day 20. In the fetal part of the placenta, under the same conditions, we observed a decrease in LC3B-II level on gestational day 14 and an increase in LAMP-2 level by the end of pregnancy. In the fetal brain, a decrease in Beclin-1 level from gestational day 14 to gestational day 20 was shown in the both study groups, while under the influence of hyperhomocysteinemia, the levels of the autophagy markers remained unchanged. Under L-methionine load, pathological ultrastructural changes were observed in the fetal part of the placenta and fetal brain at the both time points studied. Normally and under the influence of hyperhomocysteinemia, autophagosomes were found in placental cells on gestational days 14 and 20, while in brain cells, they were only present on gestational day 20.

CONCLUSIONS: The data obtained suggest that autophagy activity in the placenta and fetal brain in normal conditions and under maternal hyperhomocysteinemia depends on the gestational age. Changes in the dynamics of autophagy may be a reason for impaired placental formation and dysfunction in hyperhomocysteinemia. The absence of significant changes in autophagy markers in the fetal brain under hyperhomocysteinemia conditions may result from protective mechanisms in the placenta or/and the resilience of autophagy processes in nervous tissue.

BACKGROUND: The creation of an experimental model of adenomyosis is of scientific and practical interest, which allows for the evaluation of the effectiveness and pathogenetically substantiated therapy of adenomyosis in the future on the created highly reproducible model of the disease.

AIM: The aim of this study was to create a highly reproducible model of adenomyosis in neonatal Wistar rats.

MATERIALS AND METHODS: This article presents the first stage of the experiment on newborn Wistar rats, including the creation of a highly reproducible model of adenomyosis with different schemes and frequency of tamoxifen administration, as well as different periods of animal withdrawal. To achieve the set goal, 26 newborn female rats were orally administered an estrogen receptor blocker (tamoxifen 20 mg) at a rate of 1 mg of the drug per 1 kg of animal body weight once a day. To determine the most optimal regimen for administering tamoxifen, the animals were divided into four groups. Group 1 (n = 6) received the drug from day 2 to day 5 of postembryonic development. Group 2 (n = 8) received the drug from day 3 to day 8. Group 3 (n = 7) received the drug twice: from day 3 to day 8 and from day 25 to day 29. Group 4 (control, n = 5) only received water without the drug. The animals were withdrawn from the experiment on days 16, 30, and 90. Adenomyosis was confirmed by morphological examination.

RESULTS: Tamoxifen should be administered once to create an adequate rat model of adenomyosis, from day 2 to day 5 of postembryonic development, and the animals should be withdrawn from the experiment on day 30 of life, when the severity of the disease is sufficient and is confirmed by morphological examination. Such the scheme is reproducible and economically advantageous.

CONCLUSIONS: The creation of the described model of adenomyosis is important for conducting further studies on the treatment of the disease using various schemes, methods, and dosages in alternative methods of therapy to be described in the second part of the experiment.

The replacement of muscle tissue with fat plays the leading role in the development of sarcopenia against the background of weakening muscle function. Normally, the distribution of adipose tissue in the body has gender differences. The redistribution of fat deposits is noted with age under the influence of sex hormones: from the neonatal period, with changes in prepubertal and pubertal age, to changes in the premenopausal and climacteric periods. Racial and genetic characteristics also affect the excess deposition of visceral and subcutaneous fat. This literature review covers aspects of regulation of adipose tissue distribution in age and gender aspects, variants of pathological fat deposition, and possible health effects. Particular attention is paid to the genetic regulation of fat metabolism, the gene ERS1 (rs2175898), BDNF (rs6265), LEPR (rs1137101), FTO (rs9939609), AGT (rs4762 and rs699), FABP2 (rs179988), and only with the PPARG Pro/Pro locus were found to be associated with obesity. We discuss herein possible ways of modification of fat deposits in the human body under the influence of food stimulation, physical exercise and changes in the intestinal microbiome. These same ways are characteristic for preventing the development of sarcopenia in both the elderly and young people with secondary sarcopenia.

A comprehensive literature review was conducted on the use of thromboelastography in the diagnosis and treatment of abnormal uterine bleeding. Thromboelastography is a highly informative method for assessing blood coagulation properties, enabling a detailed analysis of all stages of hemostasis, including clot formation dynamics, clot strength, and the efficiency of fibrinolytic processes, thereby providing a comprehensive evaluation of the coagulation system. During and after the COVID-19 pandemic, the importance of thromboelastography has increased significantly as it facilitates the detection of hypercoagulable states, which is critical for patients at high risk of thrombosis. Despite the limited use of thromboelastography in routine clinical practice, its potential in the diagnosis and monitoring of coagulopathies, particularly in conditions of increased thrombosis, makes this method a valuable addition to traditional coagulation tests. The use of thromboelastography enhances the diagnostic capabilities in abnormal uterine bleeding by not only identifying coagulation abnormalities, but also differentiating their underlying pathophysiological mechanisms. This is particularly important in cases where standard diagnostic and therapeutic approaches prove ineffective, as well as in patients with combined coagulopathies who require a personalized treatment strategy.

The review discusses effective and safe methods of laparoscopic ovarian drilling in clomiphene-resistant women with polycystic ovary syndrome.

Paper search and analysis was completed using the PubMed, Embase, Cochrane Library, and Google Scholar databases. Included are publications made from 1989 to 2024. Authors identified a total of seven cohort studies, two case series, two randomized controlled trials, and one systematic review.

Laparoscopic ovarian drilling helps to overcome anovulatory infertility in clomiphene-resistant women with polycystic ovary syndrome. This method is based on mechanical destruction of follicles and part of the ovarian tissue, which leads to a decrease in androgen levels and an increase in follicle-stimulating hormone levels, resulting in restoration of ovarian function. According to available data, laser vaporization and monopolar electrosurgery are preferred methods. They are considered safe for ovarian tissue and allow for preserving the ovarian reserve. Bipolar electrosurgical techniques, on the other hand, are not recommended due to their high heat levels applied to ovarian tissue and potential impact on follicles.

At present, the leading method of laparoscopic ovarian drilling is under discussion since the research data are controversial.

Lymphangiomas are benign tumors consisting of thin-walled and intersecting lymphatic channels of various sizes and shapes. These anomalies are the result of a malformation of the lymphatic system. Lymphangiomas may occur in various anatomical regions, develop slowly, often remain asymptomatic, and are most prevalent in children and adolescents, making this clinical case particularly interesting to discuss.

The clinical case presents a rare localization of lymphangioma—in the clitoral region—in an 18-year-old female. This study emphasizes the need to increase awareness among physicians of various specialties about the existence of such rare pathologies, their clinical significance, and optimal treatment modalities. Since there is still no established treatment algorithm for this disease, the authors believe that the best treatment plan should be based primarily on the patient’s comfort and the treating physician’s experience. The analysis of such clinical cases will contribute to the expansion of the knowledge of practitioners and the improvement of their professional skills. Furthermore, it will serve as a useful guide for future studies of lymphangiomas of different localizations.

The main goal of in vitro fertilization is a clinical singleton pregnancy with the birth of a healthy child. However, many researchers suggest that assisted reproductive technology programs may increase the incidence of monozygotic multiple pregnancies among patients receiving fertility treatment. Risk factors for multiple monozygotic pregnancies include older maternal age, additional embryo manipulation, and prolonged embryo culture to the blastocyst stage.

This paper provides a review of publications concerning multiple monochorionic pregnancies after the implementation of assisted reproductive technology programs. The clinical case of infertility treatment in a woman of advanced reproductive age is presented, and a clinical quadruplet pregnancy was documented following a single frozen-thawed embryo transfer. The authors analyzed this case and suggested the reasons for the multiple pregnancy. The outcome is described, and it is concluded that even selective embryo transfer does not completely eliminate the risk of multiple pregnancy. Μonozygotic pregnancies are considered as high-risk pregnancies due to increased incidence of preterm birth, early pregnancy loss, congenital anomalies, and fetal growth restriction. Further research is required to identify the risk factors associated with monozygotic pregnancies in cycles of infertility treatment involving assisted reproductive technologies.