Aim: To study the possibilities of using telemedicine consultations in the work of an obstetrician-gynecologist.

Design: Retrospective case series.

Materials and methods. An analysis of 319 doctor — patient telemedicine consultations conducted by obstetricians-gynecologists of the MD Medical Group “Mother and Child” was carried out. Each consultation was characterized by 7 parameters: the format of communication, the relevance of the topic of the question to the profile of “obstetrics and gynecology”, the motivation to consult with a doctor remotely, the patient's complaints, the type of the follow-up medical care required and its urgency, the possibility to complete the consultation without a mandatory visit to a face-to-face appointment.

Results. 313 (98.1%) consultations had the subject of obstetrics, gynecology or reproduction. Most often (210; 61.7%) patients wanted to receive a preliminary consultation to determine the need for face-to-face visit to the doctor. The most common issues for consultation (100; 31.9%) were topics related to the management of pregnancy. The vast majority of requests (296; 94.6%) did not require an emergency call for an ambulance or an urgent visit to a doctor. In 148 (47.3%) consultations, the consultant's qualification allowed answering all questions, but despite this, according to the Russian Federation legislation, it was recommended to consult a doctor face-to-face.

Conclusion. With a systematic approach to the introduction of telemedicine consultations, their effectiveness may not be lower compared to the effectiveness of similar traditional visits with comparable safety and significant savings in resources for both the patient and the healthcare system as a whole.

Objective of the Review: To present the available data on the impact of obesity on woman’s health and quality of life.

Key Points. The term “metabesity” includes a range of conditions associated with obesity and its sequelae. From pathogenic point of view, it is an obesity-associated metabolic aberration: subacute inflammation, mitochondrial dysfunction, and changed gut microbiome. Together with a genetic component, the phenotypes of metabesity are mostly a result of sedentary lifestyle and unhealthy eating. Metabesity is associated with a number of both health- and life-threatening comorbidities, including arterial hypertension, cardiac failure, myocardial infraction, and stroke. Insulin resistance, hypertensive disease, advanced arteriosclerosis, dyslipidemia and fatty hepatosis are more frequent in obese people than in the general population. This literature overview presents a modern idea of the metabesity impact on the long-term health of a woman.

Conclusion. Recently, forecasting and prevention of diseases affecting the quality and duration of life have been attracting more and more interest. Taking into account the regular changes in the gender component of the population with age, obesity and its impact on the health of women from various age categories are of special interest. Obesity increases the risk and overall cancer mortality. Metabesity affects hormonal homoeostasis in the female body and increases the risk of degenerative conditions, including dementia. Taking into account the genetic component, the strategies to tackle metabesity, including a campaign against sedentary lifestyle and unhealthy eating, should be initiated since early childhood. Lifestyle modification is the only proven way to manage/prevent metabesity and associated diseases.

Aim: Evaluation of immune response factors in the treatment of mild cervical neoplasia against the background of human papillomavirus in patients of childbearing age.

Design: Prospective study.

Materials and methods. The study included a survey of 210 patients of fertile age. Among them were 150 patients with human papillomavirus (HPV) and cervical intraepithelial neoplasia, established by histological examination. Patients underwent Pap test, extended colposcopy, determination of HPV type and viral load. Patients with suspected pathology of the cervical zone underwent multifocal biopsy of the cervix. When analyzing changes in the cervix zone, the levels of interferon-ã, interleukin-18, caspase 3 and 9 were evaluated.

Results. Among patients with cervical neoplasia of the first degree, the concentration of caspase 3, caspase 9 and interferon-ã at the first stage of the examination was higher (p < 0.05) than the values in the control group (among conditionally healthy women without viral load), while interleukin-18 was significantly lower (p < 0.05). In subgroups I and II, after 3 and 12 months, the concentrations of the studied parameters significantly differed from those in the control group and values before treatment (p < 0.05), while, after 12 months, the values of caspase 3 and caspase 9 in the subgroup where therapy was carried out (subgroup II) were significantly lower than in subgroup I. Also, among the patients, there was a statistical difference in the values of the cytokine series, however, the level of interleukin-18 in subgroup II after 10 days and 12 months was significantly higher than in subgroup I. fluctuations in indicators made it possible to justify the use of immunocorrective therapy for the treatment of a mild neoplastic process of the cervical zone.

Conclusion. The results of the study allow optimizing approaches to the treatment of women of childbearing age with mild cervical neoplasia on the background of HPV.

Aim: Clinical and morphological evaluation of the effectiveness of the hysteroscopic metroplasty using the pulsed diode laser in case of the intrauterine septum.

Design: Retrospective comparative study.

Materials and methods. A comparative analysis of the effectiveness of the metroplasty, specific features of the course of the surgery, postoperative period, status of the endometrium and reproductive function was performed in 39 women (1^st group) who underwent the surgery with the use of the pulsed diode laser and 19 patients (2^nd group) who underwent bipolar electrosurgery.

Results. When using the proposed method of metroplasty, the dissection of the intrauterine septum was statistically significantly more often optimal (82.05%) (p < 0.001). The morphological structure of the endometrium after metroplasty in patients of the 1^st group significantly more often corresponded to the phase of the menstrual cycle (86.36%; p = 0.044) and was less often changed due to manifestations of perivascular fibrosis (12 (54.55%) of 22; p = 0.037). In most women of the 1st group, pregnancy ended in timely delivery — 15 (71.43%) out of 21 (p = 0.013).

Conclusion. The proposed method of metroplasty is an effective and safe method of dissection of the intrauterine septum, which has a positive effect on reproductive function.

Aim: to assess the severity of the pathomorphological response according to the classification of Residual Cancer Burden (RCB) in patients with breast malignancies depending on the surrogate molecular biological subtype after neoadjuvant drug therapy (chemotherapy ± anti-HER2 therapy).

Design: Retrospective comparative study.

Materials and methods. The retrospective study included 90 patients with breast cancer (T0-3, N0-1, M0) with luminal In HER2-negative, luminal In HER2-positive, HER2-positive non-luminal, thrice negative subtypes who were on complex treatment. The age of women ranged from 26 to 39 years (median age — 36 years). A retrospective analysis of the evaluation of residual tumor load in 85 patients according to the RGB system after neoadjuvant drug therapy and subsequent surgical treatment was performed.

Results. In patients with luminal B HER2-negative breast cancer, a complete pathomorphological response was noted in 20% of cases, in 16% — RCB-I, in 36% — RCB-II, in 28% — RCB-III. Among women with luminal B HER2-positive breast cancer, a complete response was achieved in 26.67%, RCB-I was noted in 33.33%, RCB-II — in 13.33%, and RCB-III — in 26.67%. Among the patients with HER2-positive breast cancer, 46.16% had RCB-0, 23,08% had RCB-I, 15.38% each had RCB-II and RCB-III. In participants with thrice negative breast cancer, a complete response was achieved in 41.94% of cases, RCB-I was noted in 22.58%, RCB-II — in 19.35% and RCB-III — in 16.13%. The frequency of complete pathomorphological response (RCB-0) after neoadjuvant chemotherapy significantly differed among the more aggressive subtypes of breast cancer (thrice negative and HER2-positive), compared with HER2-negative (p < 0.0001).

Conclusion. The unified assessment of the residual tumor after neoadjuvant therapy makes it possible to clearly identify prognostic groups of patients with different treatment responses and plan additional drug therapy for them.

Aim: Based on the study of the history, course of pregnancy and childbirth, to assess the risks of venous thromboembolic events among women with major obstetric syndromes.

Design: Retrospective cohort study using the continuum sampling method.

Materials and methods. 200 birth histories were analyzed: group 1 — 55 women with great obstetric syndromes, group 2 — 145 pregnant without them. The history of women, pregnancy outcomes were studied, and an analysis of the risks of venous thromboembolic complications was carried out.

Results. Anamnestic risk factors for major obstetric syndromes were a family history aggravated by early thromboembolic events (RR = 3,13; 95% CI: 1,34–7,30), unemployed status (RR = 1,73; 95% CI: 1,32–2,65), preeclampsia in the past (RR = 23,46; 95% CI: 1,28–428,80), first pregnancy (RR = 1,63; 95% CI: 1,04–2,55), chronic arterial hypertension (RR = 8,45; 95% CI: 1,76–40,66). There was a significant increase in the risk of venous thromboembolic complications in patients of group 1 during pregnancy (1 (1–2) points; p < 0.001) and in the postpartum period (3 (1–4) points; p < 0.001).

Conclusion. Prognostic markers of great obstetric syndromes were aggravated family and personal obstetric anamnesis, parity, low social status, chronic arterial hypertension. A significant increase in the risk of venous thromboembolic complications in pregnant women and puerperas with major obstetric syndromes was revealed.

Aim: The aim of the study was to optimize diagnostic, treatment and preventive measures in pregnant women who had a new coronavirus infection (NCI) COVID-19 during the gestation period.

Design: Comparative study.

Materials and methods. We studied the course of pregnancy, childbirth and perinatal outcomes in 60 women who had COVID-19 during this pregnancy, delivered in the conditions of the MONIAH. Patients were divided into two groups depending on the period of visit to the outpatient department of MORIAG. Group I consisted of 45 pregnant women who underwent NCI in the I–II trimesters with subsequent treatment and observation in the conditions of the polyclinic department of MONIAH, Group II — 15 pregnant women who had had NCI during gestation and applied to the polyclinic department before delivery. In the course of the work, in addition to the general clinical examination, an extended study of the hemostasis system was additionally carried out (during registration, before delivery and according to indications in order to control ongoing therapy), ultrasound and Doppler studies in dynamics, analysis of gestational and perinatal outcomes, the timing of the disease and course of the NCI.

Results. During the first consultation, all participants in the study underwent ultrasound and an analysis of standard hemostasiological tests was performed. In pregnant women who received low molecular weight heparins, as well as in cases of placental insufficiency and/or structural changes in the placenta, thrombodynamics was studied (n = 21). Women of group II had a significantly lower APTT, a higher level of prothrombin in the blood, and they also had statistically significantly more signs of hemodynamic disturbances in the BMD. According to ultrasound findings, uteroplacental blood flow disorders were diagnosed in 13 patients; thrombodynamics test results demonstrate hypercoagulation in 17 women, while the data from the routine assessment of hemostasis did not go beyond the reference values. Structural changes in the placenta were found in 8 (53.4%) examined patients of group II, and a thrombodynamic test was performed in 5 of them. Hypercoagulation was detected in 4 (26.7%) patients in group II. In patients of group I, depending on the results obtained, correction of therapy was carried out, followed by ultrasound control of the structure of the placenta, as well as an assessment of the thrombodynamic test.

Conclusion. Women who have undergone NCI during gestation, regardless of the clinical course and duration of infection with NCI, are characterized by hypercoagulable changes, however, standard hemostasiological tests do not fully reflect post-covid changes, in contrast to the thrombodynamic test in combination with careful placentometry, in which structural changes in the placenta and violations of intraplacental blood flow may indirectly indicate the presence of hypercoagulability. Rational anticoagulant and antiplatelet therapy under the control of indicators of the blood coagulation system and the structure of the placenta contributes to a significant reduction in the incidence of adverse obstetric and perinatal outcomes.

Aim: To assess the capabilities of microwave radiothermometry (MRTM) in early diagnosis of Postpartum endometritis and uterine suture failure after caesarean section.

Design: Prospective non-randomized clinical trial.

Materials and methods. A comparative analysis of the sensitivity of ultrasound (ultrasound) with dopplerometry and MRTM in the diagnosis of endometritis and suture failure on the uterus after cesarean section was carried out. The study included puerperal women after abdominal delivery (n = 90): 24 patients with a puerperia complication in the form of endometritis (group I), 16 — with suture failure on the uterus (group II), 50 — with a physiologically occurring postoperative period (control group). Assessment of the condition of the uterus and the postoperative suture on it was carried out on the 3–4th day after the operation.

Results. Despite the fact that ultrasound with dopplerometry assessment of blood flow in the branches of the uterine arteries makes it possible to assess the structure of the myometrium and with a fairly high degree of probability to identify its inflammatory changes and defects in the suture, the sensitivity of this method in the early (3–4th day of the postoperative period) diagnosis of endometritis after abdominal delivery reaches an average of 54.2 ± 23.5%, and in the insolvency of the suture on the uterus — 31.25 ± 14.65%. At the same time, the MRTM study revealed indirect signs of endometritis in 66.7 ± 7.9% (if the conclusion is based on only one parameter — the thermoassymetry index, ITA) and 87.5 ± 8.3% (taking into account the combination of three signs), and for the insolvency of the suture on the uterus, the sensitivity of the method is 81.25 ± 4.75% for both ITA and three thermogram parameters, which is 2.6 times higher, than with ultrasound.

Conclusion. Despite the rather high diagnostic effectiveness of the ultrasound method for assessing the condition of the scar on the uterus after cesarean section, the MRTM method has advantages in the form of higher sensitivity, ease of implementation, no need for expensive equipment and specialized medical qualifications. The greatest effectiveness of the diagnosis of postpartum purulent-septic complications can be achieved only with an integrated approach with clinical and laboratory tests and functional diagnostics, and timely prevention and an integrated approach to the treatment of purulent-inflammatory diseases of postoperative puerperia contribute to a significant reduction in the frequency of severe forms of postpartum infection.

Aim: To study the changes in the structural and functional parameters of blood erythrocytes in maternity women during cesarean section, depending on the method of management of the perioperative period (PP), at all its stages.

Design: Comparative group retrospective and prospective study.

Materials and methods. The study included patients (n = 81) who underwent a planned cesarean section under spinal anesthesia (SA). The control group consisted of 38 maternity hospitals, in which PP was conducted traditionally. In the main group, 43 maternity hospitals were conducted according to the accelerated recovery program: refusal of mechanical intestinal cleansing, glucose-containing drink 2 hours before surgery, antibiotic prophylaxis 1 hour before surgery (cefazolin 2 g intravenously). Blood sampling and examination of the structural and dynamic parameters of the erythrocyte membranes of the patients' blood were carried out at different stages of PP: before CA, after the development of CA, by the end of the operation; umbilical cord blood was also examined.

Results. In the control group, the polarity of annular and total lipids, as well as the microviscosity of total lipids, did not significantly change at different stages of Cesarean section. By the end of the operation, the fluidity of annular lipids increased by 24% and the parameter of the efficiency of the transfer of excitation energy from tryptophan residues of erythrocyte membrane proteins by umbilical cord blood to pyrene ((F₀–F)/F₀) increased by 11%. In the main group, after the development of CA and by the end of the operation, the index (F₀–F)/F₀ in the membranes of red blood cells decreased by 10%; the fluidity of annular lipids increased to CA and by the end of the operation by 25%, after the development of CA — by 30% relative to the control group to CA. The dissociation constants of 1-anilinonaphthalene-8-sulfonate with plasma proteins and erythrocyte membranes in the control group up to CA differ significantly: Kd₂ is 5.34 times greater than Kd₁. The number of binding centers in erythrocytes is 12 times less than in plasma proteins.

Conclusion. The concept of PUV, which promotes rapid recovery of the patient, can prevent the intensification of oxidative-inflammatory processes, which allows the development of new therapeutic methods to improve the rheological properties of blood in many clinical conditions.

Objective of the Review: To summarize the proven prognostic and diagnostic criteria for gestational complications caused by a combination of gestational diabetes mellitus (GDM) and preeclampsia (PE).

Key points. There is an analytical review of the modern paradigm of GDM and PE, their complications, as well as perinatal and long-term outcomes for mother and child. The data on clinical, anamnestic and laboratory risk factors of PE in GDM are systematized. A close relationship between the mechanisms of PE and GDM development — angiogenic imbalance and metabolic disorders in the placenta is described.

Conclusion. GDM is recognized as an independent risk factor for the development of PE, and this risk is the greater the less GDM is compensated. Polycystic ovary syndrome and an increased body mass index as concomitant factors of metabolic disorders also increase the risk of developing PE. The supposed pathogenetic commonality of GDM and PE is the presence of oxidative stress and metaflammation, which increase insulin resistance and cause endothelial dysfunction.

Aim: To compare perinatal outcomes in the group of monochorionic discordant twins, depending on the complications of the antenatal period.

Design: Cohort retrospective study.

Materials and methods. 104 pairs of discordant monochorionic twins were examined: 44 pairs with feto-fetal transfusion syndrome (TTTS) and 60 pairs with signs of selective fetal growth retardation (SSFGR).

Results. In the TFFT + CVDGR group, cervical insufficiency was more common (p = 0.004), delivery before 32 weeks of gestation (OR = 4.84; 95% CI: 1.78–13.18) and there was a higher risk of extremely severe discordance (≥ 50%) (p = 0.018): OR = 4.12; 95% CI: 1.2–14.6. Severe asphyxia was recorded more often in children who underwent TTTS — 34 (38.6%) patients versus 26 (21.7%) newborns of the SSFGR group: OR = 2.36; 95% CI: 1.28–4.36, p = 0.006. An inverse correlation was determined between gestational age and the degree of discordance in the SSFGR group.

Conclusion. Differences in perinatal outcomes in monochorionic diamniotic twins with discordant physical development were revealed depending on the type of specific complication of intrauterine development.

Aim: Identification of coping strategies specific to individuals with various somatic pathologies and different quality of life.

Design: Retrospective, case-control.

Materials and Methods: 749 women were examined (249 did not indicate the presence of somatic pathologies, 500 indicated them in their medical history and as current, 353 had currently experienced pathologies; mean age 41.9 ± 11.48 years) using the "Ways of Coping Questionnaire", "Method of Determining Individual Coping Strategies", S. Maddi's Hardiness test, SF-12.

Results. Productive coping strategies were found to be characteristic of women with higher quality of life, while unproductive coping strategies were found to be characteristic of women with lower quality of life. Specific coping strategies were discovered that differentiate women with various diseases from healthy women. Women who reported different illnesses in their medical history or were currently experiencing them showed greater severity of unproductive coping strategies (resignation, dissimulation, confusion, distancing). Coping strategies specific to various diseases were identified.

Conclusion. The obtained results were compared with those presented in the literature. They can be used to correct coping strategies that worsen well-being and are negatively associated with patient quality of life.

An educational workshop was held on April 25, 2023 within the project “The School ‘Gynaecological Endocrinology and Menopause: Decision-Making Algorithms’”, which was dedicated to the management of peri and postmenopausal patients.

The experts (E.I. Ermakova, E.N. Kareva, Yu.B. Moskvicheva) discussed methods of menopausal disorder correction, phytoestrogen pharmacology, and consultation of overweight patients in peri- and postmenopause.