Study Objective: To find the relationship between the levels of mitochondrial signal protein sequences in blood microvesicles of pregnant women and subsequent development of foetal growth retardation syndrome (FGRS), low birth-weight baby, preeclampsia (PE) or foetuses and newborns with normal weight and height.
Study Design: Prospective comparative study.
Materials and Methods. The microvesicular blood plasma fraction of women with placenta-associated complications in the outcome of previous pregnancies was studied as a risk group for their recurrence (n = 96). The study group was divided into 4 sub-groups: sub-group IА included 32 patients with pregnancies complicated with FGRS; sub-group IB comprised 20 patients with FGRS and PE; sub-group IC included 24 pregnant women, whose newborns were small for gestation age; sub-group ID was 20 pregnant women with a history of placenta-associated complications and abnormal Doppler velocimetry results, whose postnatal weight and height did not differ from normal values. The control group consisted of 20 women with a physiological course of pregnancy. The microvesicular fraction of the peripheral blood of the patients was obtained by differential plasma ultracentrifugation. Protein of the outer membrane of mitochondria (VDAC1), mitochondrial DNA transcription and replication activator (TFAM), recombinant protein of the outer membrane of mitochondria (MFN2), and TAZ protein encoding cardiolipin modelling in oxidative damage were measured by western blot analysis using a monoclonal antibody panel.
Study Results. Plasma microvesicles in patients with subsequent placenta-associated complications demonstrated decreased levels of a number of mitochondrial proteins (VDAC1, TFAM, MFN2, OPA1). Levels of these proteins determine successful intercellular signaling on the adequate functional activity of mitochondria, their integrity and normal biogenesis.
Conclusion. The obtained results allow to make a conclusion about a pronounced violation of mitochondrial biogenesis in the body of women with intrauterine growth restriction, which probably makes a serious contribution to the development of pathology and its progression.

Objective of the Review: To present current literature data on the prediction of perinatal outcomes in pregnant women with preeclampsia and on potential strategies for improving the prediction of outcomes of pregnancy complicated by preeclampsia based on Doppler parameters.
Key points. The results of studies devoted to the choice of the most optimal Doppler indicators that can be used to predict perinatal outcome are presented. This review presents an analysis of the accuracy of Doppler parameters (pulsation index in the middle cerebral and umbilical arteries, resistance index, cerebroplacental ratio) in predicting adverse perinatal outcomes in pregnancy complicated by preeclampsia. A review of the current literature on the prediction of perinatal outcomes and management of pregnant women with preeclampsia and potential strategies improving the prediction of outcomes of pregnancy complicated by preeclampsia.
Conclusion. Currently, dopplerometry in obstetric practice is a highly accurate prognostic method for determining the perinatal outcome in complicated pregnancy. This method allows to predict the actual risk to the fetus, monitor and evaluate its degree along with other methods of antenatal care, and also allows you to choose the time and method of delivery if the risk of intrauterine death of the fetus is high.

Study Objective: To study trophoblast (TB) cells taken from various sections of the embryo using Next Generation Sequencing (NGS) on Illumina platform, and to compare data in order to identify the degree of discordance between various samples from one embryo.
Study Design: Comparative study.
Materials and Methods. For the study, we used human embryos at early development stages, which originated from artificial insemination of germ cells taken from healthy donors with normal karyotype within the scope of the in vitro fertilisation program. We selected 14 human embryos originating from insemination of oocytes of 10 donors aged 20 to 32 years old with sperm taken from 9 donors from the semen bank of the International Centre for Reproductive Medicine. Two embryos underwent degradation during defrosting. For 12 embryos, we performed a repeated TB cells biopsy from two independent sections: one biopsy from TB adjacent to inner cell mass (ICM) cells and the other TB biopsy from blastocyte pole opposite to the embryoblast.
Study Results. A comparison of molecular karyotype of TB cells taken from various sections of blastocyte in 12 embryos, 36 samples (3 sample for each embryo), demonstrated partial discordance only in one observation. In initial study, molecular karyotype of an embryo showed trisomy 16 syndrome: Seq(16)x3,(XY)x1. In the follow-up study, we found an additional deletion in the form of mosaicism in chromosome 7 section adjacent to ICM of the embryo: Seq(16)x3,(7q21.3 -> 7q36.3)x[0.5]). All other results demonstrated complete concordance irrespective of a TB section in question or a laboratory where sequencing was performed.
Conclusion. It may be concluded that pre-implantation aneuploidy genetic testing of 5-day-old embryos using Next Generation Sequencing on Illumina platform allows obtaining reliable information on chromosomal abnormalities and can be successfully used to identify aneuploidy in pre-implantation embryos.

Study Objective: Evaluation of the effectiveness of ginger extract in the treatment of nausea and vomiting light and moderate range of pregnant women.
Study Design: Observational study.
Materials and Methods. The research included 56 pregnant women with symptoms of nausea and vomiting: at the first visit they had complaints of nausea and/or vomiting being 6–16 weeks pregnant. The severity of nausea and vomiting was assessed on the Pregnancy-Unique Quantification of Emesis and Nausea scale before the start of therapy, on days 4 and 7 of treatment. The pregnant women were divided into two groups. The main group consisted of 28 women who took the dietary supplement Preginor, a comparison group — 28 patients who were given only recommendations for lifestyle and diet modification. Among 56 pregnant women who were studied, there 36 were with light symptoms of nausea and vomiting (18 women from the main group and 18 in the comparison group); 20 pregnant women had a moderate degree of nausea and vomiting (10 patients from the main group, 10 from the comparison group). Preginor contains a highly selective ginger root extract (67 mg) standardized to 5% gingerols, which corresponds to about 1 g of fresh ginger; vitamin B6 1.4 mg, magnesium lactate 112.5 mg.
Study Results. Relief of symptoms of nausea and vomiting in pregnant women who took ginger was on average 48 hours faster compared to patients who received only recommendations for lifestyle and diet modification: after 3,3 (0,5) and 5,1 (1,2) days, respectively (t = –5,60, p = 0.000). With a moderate course of nausea and vomiting, taking ginger also helped to alleviate the condition in the majority of patients (80%).
Conclusion. Preginor is an effective non-pharmacological remedy for the relief of symptoms of nausea and vomiting of pregnant women. It is advisable to recommend the dietary supplement Preginor for widespread introduction into clinical practice, raising the awareness of medical personnel and patients about its effectiveness and safety.

Study Objective: Analysis of the detection of congenital diaphragmatic hernia (CDH) in the fetus at the antenatal stage and perinatal outcomes of newborns with CDH in the Russian Federation in a sample of women who applied to the perinatal consultation of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov.
Study Design: Retrospective study.
Materials and Methods. The study included 235 cases of CDH in fetuses and newborns were selected by the federal perinatal consultation of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov. The following were retrospectively analyzed: medical and social characteristics of pregnant women, results of ultrasound and MRI examination of fetuses, delivery features and perinatal outcomes.
Study Results. The number of women with fetal CDH in the perinatal consultation of the Center continues to grow every year. In 3/4 of the treated patients, fetal CDH was detected in the 2nd trimester of pregnancy, which exceeds the European level of detection. But against this background, an extremely low level of invasive prenatal diagnosis was noted. Detection using ultrasound and MRI of liver infection in the chest, including a group with a prognosis of high neonatal survival of 2.2–4 times. The perinatal mortality rate with CDH in the Centers detection is 43.4%. The most common method of delivery is the natural birth. The optimal term of delivery with the least increase in postnatal loss should be considered the period of 38–39 weeks of pregnancy. Forecast of survival of newborns. At the same time, the Apgar score does not have statistical indicators of differences in surviving and deceased newborns, regardless of the method of delivery, which is associated with a violation of child development.
Conclusion. The level of detection of CDH and perinatal mortality of newborns is similar to the data of foreign perinatal centers that provide assistance to mothers and their newborns. Increasing the survival rate of newborns with CDH is possible with the development and implementation of an integrated system for diagnosing the severity of CDH, as this will open up the possibility of a personalized approach to the treatment of CDH.

Objective of the Review: To conduct a comprehensive analysis of the current state of the problem of obstetrics chorioamnionitis (HA).
Key Points. HA leads to an increased risk of other obstetric complications. Newborns from mothers with HA are at high risk of neonatal sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, neonatal death. The authors tend to replace the term HA with a more general descriptive term: “intrauterine inflammation or infection, or both” (Triple I). To further clarify the definition and treatment of this complex group of conditions, a set of studies is needed.
Conclusion. In recent years, there have been changes in opinion on some issues regarding the problem of HA. So, new terms were proposed, diagnostic criteria were clarified, at the same time, the main changes relate, first of all, to perinatal aspects, more precisely in the management of newborns from mothers with suspected intrauterine infection and from mothers with HA, to observe (rather than treat) those born in a satisfactory condition of full-term and late premature newborns. That is, investigators tend to favor a management strategy consisting of close observation of healthy full-term and late preterm infants suspected of having intrauterine infection, which they consider to be preferable to empiric antimicrobial therapy.

Objective of the Paper: To describe the course and outcome of a pregnancy with monochorionic-diamniotic twins with marked selective foetal growth retardation (sFGR) after laser coagulation of placentary anastomoses.
Key points. Fetoscopy-guided laser coagulation of placentary anastomoses at week 21–22 of gestation made it possible to prolong the pregnancy to the term and eliminate the risks of intrauterine foetal death, preterm delivery, and neurological complications in a larger foetus.
Conclusion. In sFGR with umbilical artery blood flow type II or III (E. Grtacós), it is possible to use placentary anastomosis or umbilical vessels coagulation in a smaller foetus. Further studies are needed with unified diagnostic criteria and outcome analysis; and pregnancy management approach needs to be developed.

Objective of the Review: Аnalysis of literature and summarizing of data on the participation of platelets in the formation of immunological tolerance during the physiological pregnancy and recurrent miscarriage.
Key points. Platelet-derived soluble factors determine their involvement in the endocrine regulation of the placenta, initiate and maintain trophoblast invasion. Platelets are able to influence the balance of M1 and M2 macrophages, inhibit the cytotoxic potential of NK cells and the antigen-presenting ability of dendritic cells. The interaction of platelets with regulatory T cells initiates the recruitment of lymphocyte cells to the site of inflammation and their activation. It has been shown that the differentiation of immune cells and changes in their functional activity, aimed at creating conditions favorable for prolonging pregnancy, are largely determined by both platelet-derived soluble factors and the formation of platelet-leukocyte complexes.
Conclusion. Platelets and products of their activation play an important role in creating the conditions necessary for the onset of pregnancy and its prolongation to full term. The functional state of platelets determines the success of placentation both directly (through the control of hemodynamic parameters in the placental vessels, increased invasiveness of the extracellular trophoblast, the effect on the endocrine background) and indirectly by modulating the functions of decidual immune cells, which determines their contribution in the implementation of idiopathic pregnancy loss.

Objective of the Review: To review all studies using dydrogesterone in threatened miscarriage and to evaluate the effect of dydrogesterone treatment on miscarriage rates in women with miscarriage.
Key points. Many years of experience in many clinical studies confirm that progestogens contribute to the preservation of pregnancy in the event of a threatened miscarriage. Dydrogesterone and progesterone are the most suitable progestogens for pregnant women. The high result of dydrogesterone in high-risk pregnancy is due to its chemical structure. This systematic review and meta-analysis includes data only from randomized trials, in particular those based on comparisons of dydrogesterone with placebo. The results demonstrate that in the group of patients treated with dydrogesterone, the frequency of miscarriages was statistically significantly lower than in the group of patients treated with placebo. These findings correlate with previous data from meta-analyses and reviews of randomized clinical trials in 2017–2021, where dydrogesterone also significantly reduced the risk of pregnancy loss in threatened and recurrent miscarriage. Moreover, the largest direct comparative randomized study IPD LOTUS (2020) demonstrated a higher efficacy of dydrogesterone compared to micronized vaginal progesterone.
Conclusion. According to the results of this systematic review and meta-analysis of randomized clinical trials based on the comparison of dydrogesterone with placebo, in the group of patients who received dydrogesterone, the frequency of miscarriages was statistically significantly lower than in the group of patients who received placebo. The use of dydrogesterone is not only justified, but an essential component of the treatment of recurrent pregnancy loss.

Study Objective: To assess the impact of caesarean section rate on perinatal outcomes of preterm birth (PB) in a level 3 hospital based on the caesarean section efficiency ratio.
Study Design: Retrospective group study.
Materials and Мethods. An analysis was made of the PB histories of women delivered by caesarean section in 2021 at the State Institution “Scientific Research Institute of Obstetrics, Gynecology and Perinatology” of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, as well as data from annual reports for the city of Dushanbe and for the institution.
Study Results. In a level 3 hospital, every third delivery is by caesarean section. It has been shown that the proportion of perinatal mortality (PM) in PD is 5.5 times higher than in urgent delivery: 84.6 vs. 15.4%. In extremely early PD (EEPB) by caesarean section, the proportion of PM was statistically significantly higher than the proportion of neonatal survival: 95 ± 4.9% vs. 5 ± 4.9% (р < 0,001). The efficiency ratio of caesarean section in the 3rd level hospital is low (0.3) due to the high relative contribution of caesarean sections for EEPD and EPB to the total number of cesarean sections and the prevalence of PM over neonatal survival for EEPB and EPB.
Conclusion. The search for reserves to reduce the frequency of caesarean section in group 10 on the М. Robson scale should be carried out among patients with EEPB and EPB.

Study Objective: to compare the effectiveness of two methods of surgical treatment of severe forms of pelvic organ prolapse (POP) in women — the original method with the combined use of own tissues and a mesh implant and the traditional method with ventricular fixation of the uterus with a nylon thread.
Study Design: Prospective cohort comparative study in parallel groups.
Materials and Methods. The study was conducted in 2012–2021. The sample included 456 patients with a verified diagnosis of “pelvic organ prolapsed” (N81.2, II and III in classification of Pelvic Organ Prolapsed Quantification), complicated by a different combination of anterior, apical and posterior prolapses. The main group included 116 women operated on according to the original technique with the combined use of their own tissues (vaginal stage) and lateral ventrofixation of the uterus/cervix with a mesh implant was performed retroperitoneal to aponeurosis in the iliac regions. The second group (comparison) included 340 patients who also underwent a two-stage operation (according to the traditional method), but the abdominal stage consisted in ventrofixation of the uterus/cervix to aponeurosis of the anterior abdominal wall in the suprapubic region with a nylon thread. The frequency of relapses during the entire follow-up period and the quality of life were assessed according to the questionnaire “Pelvic Organ Prolapse — Quality of Life” (PT-QL) during the two years after surgery.
Study Results. The frequency of relapses after surgery with uterine ventrofixation to aponeurosis in the suprapubic region with a nylon ligature (11/64; 17.2%) was statistically more significant than with the use of a mesh implant according to the original technique (3/116; 2.6%) (p < 0.001). The quality of life after treatment was higher in the main group in the first days after surgery due to a statistically significant smaller number of patients with dysuric symptoms (7/116; 63%) in contrast to the comparison group, where more than half of the operated patients noted urinary retention 76,5% (260/340) (p < 0.001). In the long-term follow-up periods, there were no statistically significant differences in the patients of the compared groups according to the results of the PT-QL survey (p > 0.05).
Conclusion. The developed method of surgical treatment of POP with the combined use of own tissues and a mesh implant provided a reduction in the frequency of relapses of the disease and a higher quality of life in the early postoperative period.

Study Objective: To analyze the nature of changes in the parameters of uterine blood flow in minimally invasive surgical treatment of intrauterine pathology with the use of the diode laser energy operated in pulsed mode or bipolar energy.
Study Design: Retrospective comparative study.
Materials and Methods. A retrospective analysis of the reports of the Doppler ultrasound examination of the uterine blood flow in 102 patients who underwent surgery in the period from 2016 till 2020 was conducted to study the dynamics of uterine blood flow parameters in minimally invasive surgeries of intrauterine pathology utilizing various types of energy. Treatment of intrauterine pathology with the use of surgical diode laser in pulsed mode was performed in 60 women (1^st group), 42 women were treated with bipolar energy (2^nd group). Resistance index (RI) and pulsatility index (PI) in the right and left uterine arteries, arterial perfusion index (API), possibility to register the blood flow in sub-endometrial and endometrial blood vessels were evaluated while studying the uterine blood flow.
Study Results. After the surgeries performed with the use of diode laser, the IR and PI remained unchanged statistically significantly more frequently than after the surgical treatment with the use of bipolar energy: 75 and 53.34% vs 30.95 and 33.33%. API statistically significantly more frequently increased in the 1^st group (53.33%) and decreased in the 2^nd group (66.67%). The blood flow in basal and coiled arteries of the uterus in post-surgery period is registered statistically significantly more often if diode laser was used as compared to the surgeries performed with bipolar energy (43.33 and 41.67% vs 21.43 and 19.05%, respectively).
Conclusion. The use of bipolar energy in the treatment of intrauterine pathology leads to more severe uterine blood flow disturbances than surgeries with the use of diode laser. That is why it is reasonable to use the energy of a diode laser in pulsed mode in case of minimally invasive surgical treatment of intrauterine pathology.

Objectivе of the Review: To study the modern methods of diagnosis and management of bacterial vaginosis (BV) and vulvovaginitis in pregnant women complicated with insuficiencia istmicocervical (IIC).
Key points. BV in pregnant women is a topical issue for obstetrician professionals since it can cause a number of unfavourable outcomes (miscarriage, premature delivery, antenatal infections). In case of impaired vaginal microbiocenosis in pregnant women complicated with IIC, it is preferable to use clinical scales, in particular Amsel’s criteria, with the vaginal pH being the main indicator. However, for a more complete diagnosis of vaginal dysbiosis, modern PCR-based methods are recommended. The review describes modern classification of vaginal biocenosis disorders. We discuss characteristics of differential therapy of BV and anaerobic vulvovaginitis with pН 4.5+, and the possibility of using metronidazoles and clotrimazoles in pregnant women for vagina sanitation before IIC correction.
Conclusion. One method for BV therapy in pregnant women is the use of a combined intravaginal product containing Metronidazole 50 mg, which is recommended both by international and Russian clinical protocols as a first line therapy, and Clotrimazole 100 mg, since BV in pregnant women is frequently associated with fungi, or they start proliferating very fast because of reduced vaginal pH during therapy, thus causing vulvovaginal candidiasis. This product can be recommended for the therapy of a mixed infection and in presence of pathological discharges in pregnant women in the second and third trimesters.

Objective of the Paper: To individualise the treatment programme for patients with advanced BRCA-associated ovarian cancer.
Key points. Ovarian cancer is a highly aggressive disease characterized by low overall survival rates. The search for molecular markers, predictors of the effectiveness of drug therapy, is an urgent area of research. The article describes a clinical case of a fundamentally new approach to the combined treatment of a patient with BRCA1-associated advanced ovarian cancer.
Conclusion. Molecular testing proved tumor resistance, which evolved during neoadjuvant therapy, so adjustment of the drug regimen was required. A comprehensive approach in the assessment of molecular genetic status and tumor prevalence allows to individualize the treatment program for patients with advanced BRCA-associated ovarian cancer.