Aim: Analysis of the features of a comprehensive laboratory and instrumental assessment of the state of the fetoplacental complex and perinatal outcomes in the be-radiation, which have undergone a new coronavirus infection caused by SARS-COV-2, at different stage of gestation.

   Design. The one-central prospective cohort comparative study for the period from April 2020 to March 2023 conducted a survey of 625 pregnant women who underwent COVID-19 of varying severity at different gestation periods observed in the Moscow Hospital named after S.S. Yudin.

   Materials and methods. The study included 700 pregnant women: 625 women who have undergone COVID-19 of varying severity at different gestation periods (main group) and 75 with a normal pregnancy without COVID-19 (comparison group). Pregnant women who have undergone a new coronavirus infection were divided into groups depending on the gestation period: I trimester — 32 (5.1 %), II trimester — 168 women (26.9 %), III trimester — 425 (68.0 %). All patients conducted an ultrasound examination, including echography with biometria in accordance with the adopted protocols for the gestation, 1 and 2 screening studies under the Astraia program and on protocols adopted in Moscow; Dopplerometry in the uterine arteries, the arteries of the fetal-placental, the middle cerebral artery, the venous duct of the fetus; assessment of localization, thickness and structurality of the placenta; the amount and quality of amniotic fluid; cardiotocography. Based on the results of the primary ultrasound examination according to the indications, non -invasive prenatal testing, therapeutic amniocentesis and amniodrainage were carried out.

   Results. The frequency of almost all parameters of violation of the state of the fetoplacental complex was statistically distinguished, the differences in the frequency of violations of the uterine-placental blood flow, especially among women who transferred COVID-19 to the first half of gestation, were most significant in comparison with the control group (among the gestational-hay diabetes (among all groups of women with NCI), anemia of varying severity. The frequency of low water also turned out to be significant, and in 19 observations of 118 (16.1 %) — this was a pronounced inexumpit and anhydramnion in the III trimester of gestation. The large frequency of thrombotic complications in women who have been the COVID-19 in terms of 22–38 weeks of pregnancy is noteworthy, which requires the expansion of indications for the prevention of a given type of pathology in women, including with the use of NMGs who have suffered even easy and moderate forms of the disease. 3 women with multi-guide (3/56 (5.4 %)) required amnio-adiralization.

   Conclusion. Based on the data we have received and the analysis of the literature, we can conclude that short-term and long-term consequences for the development of children from mothers who have arisen during pregnancy COVID-19 are alarming, requiring an additional diagnostic search and dynamic postnatal observation.

   Aim: to evaluate the frequency of postpartum hemorrhage (PPH) in a high risk hospital, to conduct a comparative assessment of the clinical, historical and laboratory features of patients with PPH, and the effectiveness of the algorithm of PPH management after vaginal birth (VB) and caesarean section (CS).

   Design: retrospective study.

   Material and methods. The study included 15,480 patients. The frequency of early PPH and the effectiveness of applying a local stepwise algorithm for management of PPH were evaluated. Clinical historical and laboratory data were obtained by copying from the primary documentation.

   Results. The incidence of PPH in a high risk hospital is 0.67 %. The most significant risk factor for PPH is the induction of labor, but more than a third of women do not have significant risk factors. The volume of blood loss after CS was 1218.29 ± 728.15 ml, after VB — 784.12 ± 304.44 ml (p < 0.001). Uterine balloon tamponade was used in 28 (44.4 %) women with PPH after VB and in 27 (65.9 %) after CS (χ² = 4.600; p = 0.142). Compression sutures on the uterus were used in 12 (29.3 %) patients after CS and in 3 (2.9 %) puerperas after VB (χ² = 2.8; p = 0.001). Hysterectomy was performed in 4 (9.8 %) cases only after CS.

   Conclusion: The existing algorithms for management PPH are highly effective and allow avoiding hysterectomy in VB in 100 % of cases, in CS — in 90.2 %.

   Aim: to study the health status of newborns in mothers who have undergone a new coronavirus infection (NCI, COVID-19) at different gestation period.

   Design: a prospective cohort uncontrolled study.

   Materials and methods. 162 newborns were examined, born to women who had had NCI during pregnancy and had no clinical manifestations of the disease at the time of delivery. Group 1 included 38 children whose mothers had NCI in the 1^st trimester of pregnancy; group 2 — 74 children with the manifestation of infection in mothers in the 2^nd trimester; group 3 — 50 children whose mothers had NCI in the 3^rd trimester.

   Results. In children of groups 1 and 3, clinical and laboratory manifestations of intrauterine infection were detected in 42.1 % and 32 % of cases, perinatal lesions of the central nervous system (CNS) 15.8 % and 36 %, respectively, respiratory disorders — 10.4 % and 20 %, intrauterine development delay (IVD) in 10.4 % and 12 % of cases. The most frequent pathological condition of group 2 newborns was transient disorders of carbohydrate metabolism — 32.4 %. Congenital malformations were more common in children of group 1, 15.8 %.

   Discussion. The analysis of the literature data and the results of our study dictates the need for further study of the mechanisms of influence of the SARS-CoV-2 virus on the course of pregnancy and the health of newborns.

   Conclusion. In the absence of statistically significant differences in the frequency of pathological conditions in newborns of the selected groups, their severity was higher in children whose mothers underwent NCI in the 1st or 3rd trimesters of pregnancy, which is confirmed by the nature of the pathology, the need for transfer to specialized neonatal units.

   Aim: to describe modern methods of diagnosis, therapy and surgical correction of urinary system obstruction in the fetus, as well as gestational outcomes for the fetus with various options for intrauterine correction or without it.

   Key points. Obstructive uropathy in fetuses is a complex of intrauterine morphological and functional changes in the urinary tract, which develop as a result of a violation of the passage of urine of various origins. The authors studied modern approaches to the management of patients with obstructive fetal uropathy and methods of intrauterine correction of this pathology. The pathogenesis, emerging complications, key diagnostic biomarkers are considered based on the materials of domestic and foreign articles on this topic, posted in the eLibrary and PubMed databases.

   Conclusion. Conducting intrauterine bypass surgery in obstructive fetal uropathology can help reduce the risk of adverse perinatal outcomes, prevent the development of complications from other organs and systems and prevent disability of children.

   Aim: assess the impact of psycho-emotional stress on the course of pregnancy at various times, as well as consider the possibility of reducing it with the help of vitamin-mineral complexes.

   Key Points. Pregnant women, like all others, are influenced by a variety of stress factors, and about 30 % of them at different stages of gestation realize clinical manifestations of psychological stress. The article considers issue related to the causes of psychological stress before and during pregnancy, identifies the most vulnerable categories of women. Data on the influence of psychological stress on pregnancy outcomes and postnatal development are presented. Attention is paid to modern ideas about the pathogenesis of the damaging effect of psychological stress on various body systems, including the microbiome. Emphasis is placed on the role of an obstetrician-gynecologist as an attending physician in the timely identification of women with signs of psychological stress, in the organization of non-drug care and rational pharmacological support. Pathogenetically justified possibilities of using vitamin and mineral complexes to compensate for the negative effects of psychological stress at the preconception stage and during pregnancy were discussed.

   Conclusion. Stress before and during pregnancy affects the offspring in the long term, disrupting their physical condition, negatively affecting the functions of the central nervous system. In modern obstetric practice, medical alertness, timely consultation with specialists and the full use of all the possibilities of non-drug and pharmacological support aimed at overcoming anxiety and stress at each stage of gestation will be relevant.

   Aim: to examine the features of risk factors and cardiovascular diseases in middle-aged women with a focus on period of the menopausal transition, which is of key importance to early prevention.

   Key Points. The studies showed distinct patterns of adverse changes in fat distribution, lipid profile, structural and functional indicators of vascular health during the menopausal transition regardless of aging.

   Conclusion. The cardiometabolic health of middle-aged women is systematically underestimated; the period of menopausal transition may be a critical window of opportunity for initiation of early preventive interventions based on a multidisciplinary approach and menopausal hormone therapy.

   Aim: analysis of modern views on the pathogenesis of complications and long-term consequences of sex hormone deficiency among patients with premature ovarian insufficiency (POI), as well as the possibilities and strategies of hormone replacement therapy (HRT) for their treatment and prevention.

   Key Points. The consequences of a sex hormones deficiency in women with POI are not only short-term clinical manifestations similar to menopause, but also long-term negative outcomes for general health and life. HRT has therapeutic and prophylactic potential for all clinical aspects of the disease. However, the currently developed standard therapeutic strategies do not always allow to completely stop the symptoms of POI and ensure reliable prevention of complications in the future.

   Conclusion. The choice of adequate doses and composition of HRT, along with an interdisciplinary approach to the treatment of this pathology, will make it possible to level the associated risks and ensure a high quality of life for patients.

   Aim: To assess the severity of menopausal symptoms and quality of life in patients with iatrogenic menopause depending on the therapy.

   Design: A randomised parallel group clinical study.

   Materials and methods. The study enrolled 60 patients of reproductive age with iatrogenic menopause following bilateral ovariectomy who had a history of reproductive tumours. The patients were randomised into 2 groups. Group 1 (n = 34) was treated with escitalopram as follows: 5 mg once daily — 7 days, 10 mg once daily — 2 weeks, then 10 mg daily (subgroup 1а) or 20 mg daily (subgroup 1b) — 12 weeks. A dose of 20 mg daily was used where the frequency and severity of menopausal symptoms did not fall below 50 % in 3 weeks with a dose of 10 mg daily. Group 2 patients (n = 26) were prescribed an herbal product called cimicifuga racemosa essence (BNO 1055) at a dose of 6.5 mg 1 tablet once daily for 15 weeks. The patients' condition was assessed using a daily hot flash questionnaire; Quality of Life Questionnaire SF-36; Greene Climacteric Scale; and Insomnia Severity Index.

   Results. The number of hot flushes reduced in all subgroups; however, the reduction was statistically significant only in subgroup 1a. Greene Climacteric Scale showed that following 15 weeks of therapy in subgroup 1a there was significant reduction in the intensity of menopausal symptoms, anxiety and depression, improved somatic signs, reduced severity of vasomotor symptoms, and improved libido vs. baseline. Subgroup 1b patients demonstrated statistically significant reduction in menopausal symptoms and anxiety. Group 2 had marked reduction in menopausal symptoms and depression. Intergroup comparison demonstrates that the most marked effect from the therapy on menopausal symptoms, anxiety, depression and severity of vasomotor symptoms was observed in subgroup 1а vs. subgroup 1b and group 2. Quality-of-life assessment showed significant improvement in the physical component in group 2 patients, while psychological improvements were better in subgroup 1а after 15 weeks of therapy. Subgroup 1a patients had significant reduction in Insomnia Severity Index, while subgroup 1b and group 2 patients did not demonstrate any significant reduction in this parameter.

   Conclusion. Patients, for whom hormonal menopause therapy is contraindicated, including patients with hormone-driven malignancies, require therapy to improve their quality of life, manage their menopausal syndrome, correct psychoemotional state and improve sleep. The study demonstrated efficacy both of non-hormonal antidepressant escitalopram (a selective serotonin reuptake inhibitor) and BNO 1055 essence (a medicinal product). In mild and moderate menopausal syndrome, it is recommended to use BNO essence, while severe cases should be treated with 10 mg escitalopram daily, and therapy efficacy should be assessed after 3 weeks of therapy.

   Aim: to investigate alternative option to prevent age-associated pathology in women, caused, by progressive decrease of estrogen level during the menopausal transition period.

   Key points. If there are contraindications to the menopausal hormone therapy or at the examination stage, the choice of alternative methods for prevention and treatment of menopausal symptoms and systemic metabolic disorders should correspond to a high safety and efficacy profile. This review describes in detail the pharmacological effects of the phytoestrogen resveratrol, the mechanisms of the implementation of estrogen-like, antiproliferative, anti-inflammatory and antioxidant effects and the possibility of clinical use in the form of dietary supplements.

   Conclusion. The prescription of the phytoestrogen trans-resveratrol is an alternative approach to the relief of menopausal disorders and the prevention of systemic metabolic disorders. Possessing as high bio-active and optimal safe alternative due to trans-isomer form, it is the optimal non-hormonal remedy for correcting menopausal symptoms, inhibiting some aging processes, and also has a significant potential for preventing age-related diseases.

   Aim: To assess the symptoms and severity of the coronavirus infection caused by the SARS-CoV-2 virus in peri- and postmenopausal patients on the background of various types of MHT (oral and transdermal) and in its absence.

   Design: a retrospective, cohort study.

   Materials and methods. The study included 93 postmenopausal patients who had an infection caused by the SARS-CoV-2 virus, against the background of oral MHT - group 1, transdermal MHT - group 2 at standard and low doses, without MHT - group 3 comparison. A survey of patients was conducted, including information about the symptoms, severity of the course and ongoing therapy for COVID-19.

   Results. Duration of COVID-19 illness, as well as the frequency of various symptoms of the disease in patients (cough, rhinitis, sore throat, weakness, muscle pain, fever, diarrhea, nausea, headaches) not using MHT and using various forms of MHT (oral and transdermal) did not differ significantly. When patients using oral and transdermal MHT were combined into one group and compared with the group not taking MHT, it was found that severe COVID-19 was significantly more common in the group not taking MHT.

   Conclusions. In our study, individuals who took MHT had a significantly significantly milder course of coronavirus infection compared to women who did not use MHT. More research is needed to find protective mechanisms of sex steroids against coronavirus infection in order to continue to be ready to localize and manage this infection as soon as possible.

   Aim: Review the literature data on the pathogenetic aspects of the formation of squamous intraepithelial lesions and the role of immunological mechanisms in the formation of this group of cervical diseases.

   Key Points. Cervical cancer (CC) is a multi-stage process that is often preceded by human papillomavirus (HPV)-associated intraepithelial lesions. The establishment of causal interactions between the virus and malignancy, as well as the study of epidemiological data, leads to the formation of models of cervical carcinogenesis: infection, persistence, progression to the precancerous stage, and finally, cervical cancer. Despite the clear and obvious path of malignancy, as well as the availability of generally available diagnostic methods in the arsenal of a practicing obstetrician-gynecologist, the assessment and prediction of the further development of cervical pathologies in patients of active reproductive age remains difficult. In general, cervical cancer can be considered an excellent model for understanding the staging of malignancy processes, which will be primarily associated with the impact of human papillomavirus infection and changes in the immunological aspects of endo- and exo-cervix.

   Conclusion. An analysis of sources published in the Cochrane Librare, Google Scolare and PubMed systems was carried out. In recent years, the understanding of human papillomavirus-associated tumor interaction with the host immune system has improved, so the development of new approaches targeting immune checkpoints has sparked interest in the use of immunotherapy in cervical cancer. CC is curable if detected at an early stage. However, reliable diagnostic and prognostic markers related to the physiological and pathological regulation of cervical cancer are currently not available. Therefore, the approach to the treatment of cervical cancer has remained unchanged for several decades, and new diagnostic strategies are currently required, due to the interaction of the immune system and the virus.

   To date, the course of urogenital infections is characterized by asymptomatic or erased forms, but sexually transmitted infections (STIs) do not become less dangerous and can cause severe complications such as infertility, ectopic pregnancy, chronic diseases, intrauterine fetal damage, congenital pathology and diseases in newborn children. Taking into account the extreme urgency of the problem of timely diagnosis and adequate correction of endocervix pathology, the lack of clear cytomorphological parallels with clinical data, a very significant practical and scientific interest is the comparison of the results of cytomorphological research with diagnostic data using polymerase chain reaction. This will expand the possibilities of interpreting the cytological method as a primary study for further diagnosis and treatment.

   Аim: to analyze the results of cytomorphological studies of the urogenital tract of women with sexually transmitted infections of various etiologies and to assess their significance for a personal approach to treatment.

   Design: Prospective cohort study.

   Materials and methods. For a comprehensive cytomorphological study, data on 335 female patients (mean age 31.6 ± 8.2 years) with uncomplicated urogenital chlamydia (n = 18), papillomavirus (n = 97), herpetic (n = 26), mycotic (n = 41) infections, trichomoniasis (n = 12) and mixed forms were analyzed infectious lesion (n = 141).

   Results. If there is a history of STIs, it becomes necessary to identify concomitant genital infections and vaginal dysbiosis. It is difficult to determine which pathogen caused the "launch" of inflammatory reactions, and which one joined a second time and aggravated the course of the disease. A combination of candidiasis and chlamydial infection, candidiasis and viral lesions, chlamydial infection and viral lesions is possible, therefore, in addition to molecular genetic and serological diagnostics, cytomorphological methods are necessary for the diagnosis of STIs.

   Conclusion. The modern cytomorphological methods used for the diagnosis of infections of the female genital sphere allow us to quickly and reliably determine the type of pathogen and the nature of the process, which could help clinicians to choose the appropriate therapy correctly, to prevent the transition of the disease to the chronic stage, to avoid complications and the development of neoplastic processes.

   Aim: To analyze modern approaches to the diagnosis and treatment of genital endometriosis.

   Key points. Endometriosis is one of the most common gynecological diseases, affecting mainly women of reproductive age, the main manifestations of which are chronic pelvic pain and infertility. Constant pelvic pain, which reduces the quality of life, leads to the fact that patients are in a state of prolonged stress, and they have behavioral disorders. According to the latest world recommendations, drug treatment is the first line of therapy for endometriosis, if pregnancy is not a priority at this stage. There are many imaging methods for diagnosing this disease, but the search for non-invasive markers of endometriosis that can reliably confirm the diagnosis is still ongoing.

   Conclusion. An interdisciplinary approach and the choice of adequate treatment for endometriosis at each stage of a woman's life can limit unnecessary surgery and better meet the needs of patients.

   Aim: To justify the viability and safety of local hormonal therapy with oestrogens in genitourinary syndrome of menopause.

   Key points. The overall ageing of the population results in an increased number of women who have problems during menopause associated with gradual reduction and switching-off of ovarian function and cessation of oestrogen generation by ovaries. Local changes at the pelvic level (urethra, bladder, vagina) are described as genitourinary syndrome of menopause. The most effective therapies for the syndrome include local hormonal therapy with oestrogens, including oestriol which is of interest due to its specific targeted action and lack of proliferative effect on endometrium and mammary glands. The use of oestriol eliminates a number of problems caused by oestrogen insufficiency: it minimises or eliminates dyspareunea, dryness and itching in vagina and lower section of the urogenital tract, inappropriate urination, enuresis, and recurring vulvovaginitis and cystitis.

   Conclusion. It has been proven that the local use of oestriol is efficient and safe for the management of genitourinary syndrome of menopause. The selection of a specific medicinal product should be evidence-based and should take into account the route of administration and pharmacological properties, including preparation of the active ingredient, and excipients contributing to the overall efficiency and safety.

   Aim: to provide the key trends in the use of a modern combined medicinal product of ciprofloxacin and ornidazole.

   Key points. The product has a combined antimicrobial and antiprotozoal effect; its pharmacological action is a result of the properties of the active ingredients — ciprofloxacin and ornidazole. The article describes the efficacy of this combination against gynaecological infections.

   Conclusion. The use of the ciprofloxacin and ornidazole combination demonstrates therapeutic effect against a majority of urinogenital gynaecological conditions. The product is beneficial in case of concurrent infections, various vaginitis, pelvic inflammations and for prevention of post-surgery complications.