Study Objective. To assess the structure and indicators of critical obstetric conditions and maternal deaths in the Far East Federal District of Russia before (2019) and during (2020) the COVID-19 pandemic.

Study Design: Retrospective comparative analysis.

Material and methods. We have reviewed medical records on near misses (NM) and maternal deaths (MD) for 2019 (194 and 17, respectively) and 2020 (207 and 19, respectively). Descriptive statistics, cross tables analysis with evaluation of the Pearson’s chi-square and p-value, odds ratio calculation at 95%CI were used for mathematic data processing.

Study Results. In 2019 and 2020, maternal death rate was 18.7 and 21.1 per 100,000 live births, respectively. Obstetric causes of maternal deaths demonstrated statistically significant reduction during the COVID-19 pandemic (2020) (26.3% vs 76.5% in 2019, р < 0.05); the ratio of life-threatening conditions (NMs and MDs) grew from 2.3 to 2.5; and COC (NM) coefficient soared from 2.1 to 2.3 per 100,000 life births. Reduction in the survival index from 11.4 to 10.9 and increase in the death index from 8.1% to 8.4% can evidence poorer quality of medical care.

Conclusion. Analysis of trends and indicators of the critical obstetric conditions allows evaluating the system of organisational and medical measures, revealing issues with obstetrics services and finding additional resources to reduce maternal morbidity and mortality during the emergency situation caused by COVID-19.

Study Objective: To identify predictors of early preeclampsia (PE) according to placentometry results, when an ultrasound screening is performed at week 19–21 of pregnancy in women with low risk of PE.

Study Design: Case–control study (paired comparison method).

Materials and Methods. The study enrolled 80 pregnant women. The study group included 40 patients with early PE, delivery time: week 28–32 of pregnancy. Controls were 40 women who delivered term infants without any signs of hypotrophy. We analysed ultrasound findings at week 19–21 of pregnancy in order to calculate the placental ratio score (PRi).

Study Results. Median PRi in controls was 6.68, i.e., significantly lower than in the study group (7.65 (р < 0.0001)). We calculated the threshold value of PRi which allows forecasting early PE in the low-risk group: PRi of ≥ 7 makes it possible to forecast early PE in 91.3% of cases, with the sensitivity of 90% and specificity of 87.5%.

Conclusion. Placentometry at week 19–21 of pregnancy with PRi calculation, where the length (diameter) of placenta is 120–167 mm, allows forecasting early PE in low-risk patients and timely stratifying pregnant women for additional examinations and preventive measures.

Study Objective: To assess the extent of blood loss and underlying factors in patients with placenta accreta, who underwent caesarean section, when various methods of haemostasis are used.

Study Design: Perspective study.

Materials and Methods. We performed a prospective multivariate analysis of 147 medical cards of pregnant women and new mothers, labour and delivery records for single pregnancies termination with labour or abrupt termination of pregnancy. All examined women were divided into three clinical groups. The key factor for division into groups was the type of surgery for postpartum haemorrhage because of placenta accreta. Group I included women (n = 106, mean age: 29.2 ± 2.9 years old), who underwent uterine artery embolisation; group II (n = 31, mean age: 32.2 ± 3.4 years old) had hysterectomy; and group III (n = 10, mean age: 31.6 ± 3.4 years old) underwent surgical haemostasis (uterine and ovarian vessels ligation, compression suture of uterus) without hysterectomy.

Study Results. Minimal blood loss was recorded in patients who underwent uterine artery embolisation. The rate was 176.5% lower than in post-hysterectomy women and 96% lower than in patients who underwent surgical haemostasis (p < 0.05 in both cases). The highest bloodloss rate was recorded in post-hysterectomy women, and the value was 41.1% higher than mean values for patients who underwent surgical haemostasis (p < 0.05). There is direct strong correlation between the number of deliveries and the rate of blood loss, where the overall number of deliveries was not more than two (R = 0.87, р < 0.05). However, for more than 3 deliveries, the correlation between the number of deliveries and the rate of blood loss was not statistically significant (R < 0.3, p > 0.05). The highest blood loss was recorded after 2 deliveries (p < 0.05). The group of patients who had 2 deliveries was the only examined group where the blood loss exceeded 2 L. The lowest blood loss rate was in first-time-mothers (less than 800 mL).

Conclusion. Uterine artery embolisation is the most efficient surgical method to arrest bleeding. When assessing risk factors impacting the rate of blood loss, it is essential to pay attention to the number of previous pregnancies and deliveries, as well as a history of surgical termination of pregnancy (endometrectomy) and caesarean sections.

Study Objective: To broaden the understanding of the immunological aspects of implantation incompetence of endometrium in patients with repeated implant failures (RIF) in in vitro fertilisation programs.

Study Design: Open perspective comparative study.

Materials and Methods. 57 women aged 27 to 42 years old (mean age: 36 ± 6.2 years old) with clinically verified RIF. A morphological control group included 30 fertile women with a history of at least 2 deliveries of full-term healthy children and without fertility disorders, who signed a voluntary informed consent to take part in the study. The subject of the study was endometrium biopsy material obtained on day 8–10 of menstruation (middle stage of the proliferation phase).

Study Results. In this study, endometrium biopsy material of patients with RIF demonstrated statistically significant (p < 0.05) changes in the middle stage of the proliferation phase: 1.9- and 1.5-fold increase in CD56+ and CD8+ expression, respectively; 2.2-fold reduction in CD4+ expression, and impaired CD8+/CD4+ ratio (increase in CD8+) vs morphological controls.

Conclusion. Pathogenesis of implantation incompetence in patients with RIF is caused by immunological imbalance in endometrial stroma, the substrate of which is insufficient concentrations of proangiogenic NK-cells, regulatory suppressive Т-helpers, and increased density of the cytotoxic NK- and Т-cells; it forms two primary parts of pathogenesis: reduced immunological tolerance to semiallogenic blastocyte and impaired normal angiogenesis in endometrial stroma of women with RIF.

Study Objective: To broaden the understanding of the pathogenesis of impaired receptivity in patients with repeated implant failures (RIF) in in vitro fertilisation programs.

Study Design: Open perspective comparative study.

Materials and Methods. 57 women aged 27 to 42 years old (mean age: 36 ± 6.2 years old) with clinically verified RIF. A morphological control group included 30 fertile women. The subject of the study was endometrium biopsy material obtained on day 5–7 of menstruation, following the peak blood concentration of luteinizing hormone (implantation window).

Study Results. During the implantation window, patients with RIF have statistically significant (р < 0.05) changes: 1.5- and 1.4-fold increase in gland and stromal expression of estrogen α receptors, respectively; 2.3-fold increase in expression of progesterone A and B receptors with simultaneous reduction in stromal expression by 1.6 times; focal reduction in MUC1 expression in apical surface of endometrium; 1.3-fold increase in pinopods density in apical surface of endometrium and 2.3-fold increase in stromal expression of CD56+ NK-cells; 2-fold reduction in CD4+ cell expression, and 2.2-fold increase in CD8+ expression vs morphological controls. During the implantation window, von Willebrand factor and CD34+ levels in endometrial stroma did not demonstrate statistically significant differences when expressed in blood-vessel endothelium.

Conclusion. Pathogenesis of impaired receptivity in patients with RIF can be explained with impaired expression of sex hormone receptors in stroma and glandular component and reduced MUC1 expression, increased density and reduced amount of mature and maturating pinopods in apical surface of endometrium. An increased number of expressed CD56+ NK-cells during the implantation window in patients in both groups (in patients with RIF, CD56+ expression is significantly higher) in combination with the found imbalance between Т-lymphocytes can be a cause of the immunological component of impaired implantation pathogenesis.

Study Objective: To compare clinical and anamnestic characteristics of women with endometriosis-associated (EAI) and tuboperitoneal (TPI) infertility.

Study Design: Retrospective case–control study.

Materials and Methods. The study enrolled 300 patients: 150 women with histologically confirmed EAI formed group I (study group), and 150 women with TPI who formed group II (controls). All subjects underwent clinical, anthropometric and specialised pelvic examination, laparoscopy and hysteroscopy in accordance with commonly used methods. The revised classification developed by the American Fertility Society (R-AFS) was used to evaluate the endometriosis severity and adhesive process prevalence. Pain intensity was evaluated using a visual analogue scale. All patients with endometriosis had their minimal preserved function and Endometriosis Fertility Index (EFI) calculated.

Study Results. Patients with EAI were older that patients with TPI (31 vs 29 years old, p = 0.002); they more frequently had pelvic pain (41.3%), dysmenorrhea (29.3%), dyspareunea (31.3%), abnormal uterine bleedings (12.7%) were reported only by patients with EAI (р = 0.001 in all cases). Endometriosis in these patients was localised primarily on the pelvic peritoneum, uterine ligaments and ovaries. Endometriosis stage I–II was recorded in 57% of patients with EAI, stage III and IV — in 43%; and no relationship has been found between disease stage and clinical signs of the disease. The minimal mean preserved function in patients with EAI was 12.8 ± 5.6 points, EFI — 6.7 ± 2.6 points. Endometriosis was diagnosed and verified late, at an average of 3 years after onset of symptoms.

Conclusion. Patients with EAI had some peculiar clinical and anamnestic characteristics vs. patients with TPI. Despite the fact that endometriosis was diagnosed and verified at an average of 3 years after onset of symptoms, EFI shows that the efficiency of surgery for infertility management is quite high in this group of patients. Further studies are required to evaluate the need in and the timing of laparoscopy in this category of patients.

Study Objective: To evaluate the impact of combined oral contraceptives (COCs) containing 17β-estradiol/nomegestrol acetate and ethinylestradiol/drospirenone, on the sexual function, depression prevalence and severity, and quality of women’s life.

Study Design: Randomised prospective non-interventional comparative parallel-group clinical study.

Materials and Methods. The study included 90 women requiring contraception aged 18 to 45 years old (mean age: 29.9 (6.2) years old). Patients were randomised into two groups: group I (n = 45) took 1.5 mg of 17β-estradiol and 2.5 mg of nomegestrol acetate (E2/NОMAC); group II (n = 45) — 20 µg of ethinylestradiol and 3 mg of drospirenone (20EE/DRSP). Health Survey Short Form 36 (SF-36) of the Female Sexual Function Index (FSFI-6), Beck Depression Inventory initially and after 6 months of COC were used for questionnaire.

Study Results. After 6 months of E2/NОMAC therapy, patients had better lubrication (from 4 [3; 4] to 5 [5; 5] [points, p < 0.001) and higher female sexual function index (from 24 [22; 26] to 26 [24; 28] points, p = 0.01); reduced depression prevalence and intensity on Beck Inventory (from 7 [5, 11] to 6 [3, 7] points, p = 0.005); improved quality of life in the domain “physical functioning” (from 95 [80; 100] to 95 [95; 100] points, р = 0.03), and improved overall mental health component (from 34 [31; 38] to 38 [34; 41] points, р = 0.005). When 20EE/DRSP was used, there was no dynamics in FSFI-6 Questionnaire and Beck Inventory; however, patients demonstrated improved overall mental health component (from 43.7 [34; 51] to 48.6 [43; 52] points, р = 0.02) as well as improved physical (from 100 [95; 100] to 100 [100; 100] points, р = 0.03) and emotional functioning (from 100 [67; 100] to 100 [100; 100] points, р = 0.04).

Conclusion. 6-month therapy with E2/NОMAC-containing COCs has positive effect on sexuality and promotes reduction in depression intensity, unlike COCs containing 20EE/DRSP which improve the quality of women’s life to a greater extent.

Objective of the Paper: To demonstrate possible challenges with differential diagnosis of adenomyosis and abnormal uterus development in practical paediatric gynaecology.

Key Points. We presented two cases of teenage girls with similar clinical symptoms in various diseases: nodular adenomyosis, which is rare for adolescents, and abnormal uterus development. Despite a full range of clinical and instrumental examinations (MRI, ultrasound examinations), it is only laparoscopy that allowed identifying the cause of pain.

Conclusion. It is advisable to active use minimally invasive surgical procedures in paediatric inpatient units. Clinical recommendations and medical aid procedures for this urgent pathology are required to facilitate decision-making by medical professionals to apply endosurgical methods of therapy.

Study Objective: To assess the efficacy of an antiviral in the management of HPV-associated cervical stage II intraepithelial neoplasia (CIN II), using the analysis of the apoptotic marker levels and cytokine profile — caspase 3 and 9, interferon (INF) γ, interleukin (IL) 18.

Study Design: Perspective study.

Materials and Methods. We examined 126 women of reproductive age. The study included two groups: controls (40 relatively healthy fertile women without any cervical pathologies and HPV) and a group of 86 women with HPV-associated CIN II. All subjects underwent an examination; and their cytokine response and apoptotic marker level were assessed. All patients in CIN II group had the affect area excised. 43 post-excision women were followed up (sub-group A); other 43 subjects had surgery and an antiviral (sub-group B). The antiviral was administered subcutaneously once daily, 3 injections before and 3 injections after the excision. The primary efficacy criteria were absence of HPV or reduction in the viral load below significant values, and absence of pathology relapses after 6 and 12 months of the study.

Study Results. In subjects with CIN II, pre-therapy caspase 3 and 9 levels were significantly higher vs controls; INF-γ was 1.8 times higher than in controls, and mean IL-18 concentration was considerably lower (p < 0.05 in both cases). In sub-groups A and B, caspase 3 and 9 concentration in 3 and 6 months after therapy also differed significantly from controls, and in 6 months, caspase 3 and 9 concentration in sub-group В was considerably lower than in sub-group А. Women in sub-groups А and В demonstrated statistically significant difference in cytokine profile: in both sub-groups, INF-γ concentration in 10 days increased, while in 12 months it almost reached its baseline value. IL-18 in sub-group B in 10 days and 12 months was significantly higher than in sub-group А.

Conclusion. The results of the study demonstrate high HPV elimination and reduction in relapse probability after excision in patients with CIN II with the use of antivirals.

Objective of the Review: To comprehensively analyse the potential role of Epstein-Barr virus (EBV) in development of cervical cancer.

Key Points. Human papilloma virus (HPV) is a key causative factor of cervical cancer. However, there are a lot of data collected over the last two decades demonstrating that EBV has a role to play in this process; still, its contribution to development of cervical cancer has been studied poorly. This review describes the real-time published data on EBV and HPV co-infection in the genesis of cervical cancer, and the potential role of EBV in gynaecological cancer progression.

Conclusion. EBV has an important role in the genesis and progression of some human malignancies including lymphoid tumours (both В- and Т-cell cancer) and carcinoma (nasopharyngeal and gastric cancer). The available data are indicative of potential cause-effect relations between EBV and cervical cancer pathogenesis. A frequent EBV and HPV co-infection in cervical cancer witnesses possible cancer-causing interaction between the two viruses. Thus, more in-depth studies are needed to find out the mechanisms underlying the EBV and HPV synergism and its clinical effects. Taking into account successful cervical cancer prevention with HPV vaccine and possible future EBV vaccination, the carcinogenesis mechanisms should be studied more thoroughly in order to improve the prevention of oncological diseases.