Aim. А determination of predictors of early placental abruption (up to 34 weeks of pregnancy).

Design. Multicenter retrospective cohort study.

Materials and methods. The total number of cases of placental abruption — 1594, data from 22 medical centers in 16 constituent entities of the Russian Federation. The main group (n = 618) — patients with placental abruption at a gestation period of less than 34 weeks, comparison group (n = 976) — pregnant women with placental abruption at 34 weeks or more.

Results. Multivariate analysis carried out using the logistic regression method revealed a statistically significant effect of smoking, pregnancy number, the presence of a scar on the uterine abnormalities of its structure on the occurrence of early placental abruption.

Conclusion. Disentangling placental abruption into early and late phenotypes may provide insight into the causes of this obstetric condition and improve maternal and neonatal outcomes.

Aim. To evaluate the effectiveness of surgical treatment and assisted reproductive technologies (ART) for infertility associated with stage I–II endometriosis, according to the revised American Society for Reproductive Medicine (rASRM) classification.

Design. Randomized study.

Materials and methods. This study included 62 women aged 25 to 41 years with infertility and stage I–II endometriosis, determined by clinical symptoms and magnetic resonance imaging data. Patients were randomized into 2 groups: group 1 (laparoscopy) — surgical treatment of endometriosis, followed by planning a spontaneous conception within 12 months (n = 35); group 2 (ART) — treatment of infertility associated with endometriosis using ART methods (n = 27). Reproductive outcomes in group 1 were assessed after 1 year from the date of surgical treatment; in group 2 — based on the results of 3 attempts of embryo transfer as part of the use of ART methods.

Results. Rate of pregnancy (group 1 — 34.3%; group 2 — 33.3%; p = 0.937), pregnancy termination (group 1 — 25%; group 2 — 44.4%; p = 0.397), childbirth (group 1 — 20%; group 2 — 14.8%; p = 0.643) did not differ significantly between treatment groups.

Conclusion. Surgical treatment and the use of ART methods in the treatment of infertility in patients with stage I–II endometriosis are equally effective. The choice of method may depend on the patient’s preference, medical history, characteristics and disease stage, the presence of concomitant pathology, as well as the other factors of infertility.

Aim. To determine clinical and anamnestic predictors and morphological markers of the abnormalities of labor to women delivered by cesarean section (CS).

Design. A prospective cohort study in parallel groups.

Materials and methods. The study was performed at the Department of Obstetrics and Gynecology of the Kursk State Medical University in the obstetric hospital of the Kursk City Clinical Hospital of Emergency Medical Care. 110 women were examined, in whom delivery was performed at 37–41 weeks of pregnancy by С-section. The patients were divided into two groups: the main group consisted of 65 women, whose indication for CS was abnormalities of labor activity that could not be medically corrected. The comparison group included 45 pregnant women, by CS due to the development of placenta-associated complications (acute intrauterine fetal hypoxia, premature of placenta abruption, severe of preeclampsia). The criteria for exclusion from the study were multiple pregnancies, severe extragenital pathology, and age over 40 years.

The examination of the patients included the study of general and obstetric anamnesis, objective, obstetric, ultrasound, dopplerometry, morphological studies and statistical processing of the results obtained.

Results. Statistically significant differences with a predominance to patients of the main group were revealed by the following signs: "immature" cervix at full-term pregnancy; infectious-inflammatory diseases of the pelvic organs; the placenta location of the anterior wall of the uterus; history of intrauterine curettage in the anamnesis; diseases of the cardiovascular system.

Morphological examination of patients with abnormalities of labor revealed a high degree of disorganization of the smooth myocytes (p = 0.04), significant interstitial edema (p = 0.01) and a hight degree of isolating smooth myocytes (p = 0.01).

Conclusion. The analysis of clinical and anamnestic predictors and morphological data obtained after the first CS will allow of women at risk for predicting anomalies of labor at the time subsequent pregnancy and optimizing their delivery tactics.

Aim. To evaluate the impact of changes in the treatment of pregnancy with breast cancer on the condition and characteristics of the newborn.

Design. Retrospective prospective cohort study.

Materials and methods. Evaluation and comparison of data on pregnancy management and characteristics of the condition and management of newborns in two groups. The first group consisted of 68 newborns born to mothers with breast cancer from 2013 to 2019, data from medical records were collected and analyzed retrospectively. The second (prospective) group included 75 children born to mothers with breast cancer during pregnancy from 2020 to 2023. The study was conducted on the basis of the department of newborn National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov.

Results. The study groups differed statistically in the dates of pregnancy at the time of delivery, which is due to the changed treatment of patients with breast cancer during pregnancy. In the prospective group significantly more children (61 (81.3%) child) were born pregnant (p < 0.05). The absolute majority of pregnancies in a prospective cohort of patients determined differences in the condition and behavior of newborns. Thus, in the first group of children, the duration of hospital treatment after birth was significantly shorter than in the second (4 and 7 days respectively, p = 0.000). In the prospective group with the diagnosis «Healthy» 41 (54.7%) children were discharged from the maternity hospital, in the retrospective group only 9 (13.2%) children (Yates correction, p < 0.05).

Conclusion. Studies of domestic and foreign authors have shown that in the neonatal period, the severity of the condition of children born to mothers with oncological diseases, including breast cancer, is not due to the influence of the mother’s disease and chemotherapy, The duration of gestation at birth and the extent of morphofunctional immaturity. Our research confirms that the extension of pregnancy before the delivery time significantly improves perinatal outcomes in mothers with breast cancer during pregnancy.

Aim. To evaluate the effectiveness of various variants of hemostatic sutures in the fight against obstetric bleeding caused by premature rupture of placenta and prevention of massive blood loss.

Design. Analytical review and cohort retrospective study.

Materials and methods. The analysis of the effectiveness of intraoperative hemostasis methods was carried out on the basis of data from 24 domestic and foreign scientific publications devoted to the problem of PPRP over the past 10 years (2014–2024). The information obtained was compared with the results of using a local algorithm for intraoperative hemostasis in 182 women with bleeding that occurred in the Clinical Maternity Hospital No. 2 in Volgograd in 2010–2023. The main group included 138 (75.8%) patients who underwent uterine devascularization on both sides at two levels. The comparison group consisted of 44 women who used B-Linch compression sutures: in 37 (20.3%) cases, only compression sutures were applied, in 7 (3.9%) a combination of these methods was used.

Results. According to the literature, placenta abruption is the most common cause of bleeding that required surgical hemostasis. Uterine devascularization allowed the organ to be preserved in 135 out of 138 patients, while with the use of compression sutures and their combination with devascularization, the uterus was preserved in 37 out of 44 operated maternity hospitals (OR — 8.514; 95% CI: 2.098–34.544), which confirms the statistically significant effectiveness of devascularization.

Conclusion. It is advisable to start intraoperative stop of uterine bleeding caused by placenta abruption with uterine devascularization. This relatively easy-to-perform method of hemostasis in uterine bleeding may be the method of choice in maternity hospitals of the 1^st and 2^nd groups.

Aim. To conduct a comparative assessment of the main parameters of hemostasis before delivery in patients with refractory postpartum hemorrhage (PPH) and without PPH.

Design. A retrospective case — control study (copy — pair 1 : 3).

Materials and methods. The study included 55 patients with refractory PPH (main group) and 165 women without PPH (control group). The level of hemoglobin, platelets and hematocrit were determined on a hematology analyzer Mindray BC-6800 Plus based on SF Cube technology, the level of fibrinogen and activated partial thromboplastin time — on an automatic hemostasis analyzer SYSMEX CS-1600 based on multiwave analysis technology. The volume of blood loss was estimated gravimetrically. The obtained data were analyzed and visualized using the Python programming language version 3 and the pandas, scipy.stats, matplotlib.pyplot libraries.

Results. Blood loss during delivery in the main group was significantly higher than in the control group and amounted to 1478.18 (679.78) and 462.12 (209.32) ml, respectively (p < 0.001). The fibrinogen level before delivery in women with refractory PPH was statistically significantly lower compared to the control group: 3.9 (3.3; 4.5) and 4.4 (3.9; 4.96) g/l, respectively (p = 0.002). Other hemostasis parameters did not have statistically significant differences between the groups.

Conclusion. In patients with refractory PPH, the fibrinogen level was statistically significantly lower than in women without this complication. A fibrinogen level of less than 3.95 g/L may be a predictor of refractory PPH (AUC 95% CI: 0.65 (0.55; 0.75)).

Aim. To evaluate the cholecalciferol effect on the climacteric manifestations severity and the cytokine status dynamics in women receiving phytoestrogen therapy.

Design. Prospective longitudinal case-control study.

Materials and methods. 302 women aged 48 to 57 years were examined. Of these 229 women had symptoms of climacteric syndrome (CS). At the first stage of the study, clinical signs, 25(OH)D and cytokine levels were assessed in women with CS (n = 229). The control data were the results of similar age women, but without signs of CS (control group, n = 73). At the second stage the dynamics of clinical and immunological parameters in two groups of women with CS were studied. The first group (comparison group, n = 57) consisted of patients who received phytoestrogens therapy for 6 months. The second group (main, n = 57) included women who in addition to a similar 6-month course of phytoestrogens were prescribed cholecalciferol using saturation regimens depending on the initial 25(OH)D serum levels. In the dynamics of treatment, the severity of CS manifestations was assessed, as well as the levels of 25(OH)D, interleukins IL-1â, IL-6, IL-8, and tumor necrosis factor á. After a 6-month course of therapy 55 women from the comparison group and 50 patients from the main group were re-examined.

Results. It was found that climacteric syndrome is characterized by an increased concentrations of IL-6 (p = 0.042) and IL-8 (p = 0.036) and is more often recorded in women with vitamin D deficiency (81.1% versus 68.5%; p = 0.018). The inclusion of cholecalciferol in the treatment led to a significantly more pronounced reduction in the anxiety and panic attacks severity, headaches, somatic symptoms, the overall severity of climacteric syndrome on the Green scale, as well as IL-6 level after 6 months of complex therapy. A significant decrease of IL-8 level was found only when phytoestrogens were taken in combination with cholecalciferol. The combination of phytoestrogens with cholecalciferol also provided a significant increase in 25(OH)D serum content: from 17.77 [13.58; 24.76] ng/ml to 35.47 [31.49; 43.59] ng/ml (p < 0.001).

Conclusion. The results obtained indicate the presence of favorable clinical and immunological effects of vitamin D supplementation in women with climacteric syndrome.

Aim. To present literature and own data on the implementation of the concept of patient blood management (PBM) in obstetrics and gynecology.

Key points. PBM involves “the timely, interdisciplinary application of evidence-based, multimodal medical and surgical concepts aimed at screening, diagnosing and appropriately treating anemia, minimizing surgical, procedural, iatrogenic blood loss, and managing coagulopathy bleeding to improve health outcomes through patient-centered care”. As part of the PBM, it is important for the obstetriciangynecologist to first screen for iron deficiency (ID) and identify iron deficiency anemia (IDA), prescribe treatment with modern iron preparations. A new generation of ferrous iron preparation with prolonged release is proposed, which minimizes the side effects of therapy. The second aspect is to screen and treat identified coagulation disorders using treatment algorithms based on thromboelastometry data, the third is in the postpartum/postoperative period, screen for and treat iron deficiency and anemia, control coagulation, monitor blood loss and rational use of allogeneic blood components. The results of the introduction of PBM into clinical practice of the National Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. Kulakov, which allows for timely diagnosis of ID and IDA at the “Anemia-STOP!” Center, rational transfusion of allogeneic blood components, which contributed to a reduction in the volume of procured and transfused donor blood components.

Conclusion. The implementation of the PBM concept helps to improve the effectiveness and safety of treatment, while promoting the best use of economic resources.

Aim. To clarify and summarize current data on the relationship between morphological features of gravid transformation of the endometrium and early reproductive losses in women with obesity.

Key points. The growing prevalence of obesity worldwide is of serious concern not only due to numerous metabolic complications associated with excess visceral adipose tissue, but also due to reproductive dysfunction in women. Obesity is considered a key factor that increases several times the likelihood of pregnancy complications such as spontaneous abortion, non-viable pregnancy, stillbirth, gestational diabetes mellitus, and preeclampsia. The development of adverse events in the context of maternal obesity may be based on the interaction of biological processes associated with pregnancy and chronic inflammation caused by obesity. However, the causal relationship between BMI and spontaneous abortion is not fully understood, possibly due to the multifactorial effects of excess body weight on pregnancy progression. In addition, BMI as an isolated variable may not reflect other important health risk factors such as nutrition, physical activity, and insulin resistance.

Conclusion. Female obesity is associated with worse natural and assisted conception outcomes, including an increased risk of spontaneous abortion. Low-grade inflammation affecting arterial remodeling, placentation, and uterine immune cell composition and activity in maternal obesity contributes to a high incidence of pregnancy complications. The development of a unified morphological panel that takes into account the main indicators of endometrial transformation processes with an assessment of its receptor profile and diagnostically significant immunological factors will allow verification of endometrial pathology at the molecular level and justification of pathogenetic therapy in the risk group of early reproductive losses in women with obesity.

Aim. To review the advantages and disadvantages of using an optoelectronic cervical screening method to detect cervical intraepithelial neoplasia and cervical cancer.

Key points. At the present stage, the use of optical-electronic scanning is extremely important for the best diagnosis of cervical precancerous lesions. It can help to reduce the incidence of cervical cancer and will benefit the health of women.

Conclusion. The optoelectronic technology provides sensitivity comparable to that of liquid cytologic examination of cervical micro specimens and can be used both as a primary screening method and for selection of HPV-positive patients for further diagnostic and therapeutic measures.

Aim. Consider an optimized comprehensive approach to the treatment of genital herpetic infection against the background of intimate plastic surgery.

Key points. Even when using high-quality volume-forming preparations based on hyaluronic acid, if all norms and rules are followed, possible complications include re-activation of herpes virus infection. Properly selected antiviral and immunomodulatory drugs provide postprocedural care to prevent reactivation of the herpes simplex virus and effective and safe treatment in case of exacerbation of the disease after injection of fillers.

Conclusion. Prompt prevention of re-activation and therapy, where required, of virus infections. as exemplified by herpes virus infection, allows reducing the risk of recurrence after intimate plasty and making the procedure compliant with patients' expectations.

Aim. To present a case report of membranous dysmenorrhoea in woman with polycystic ovary syndrome.

Key points. Membranous dysmenorrhea is defined as sudden sloughing of thickened endometrium as a whole with the shape of the uterine cavity. It’s more common in young females who were on either combined hormonal contraceptive or progestagen. Membranous dysmenorrhea is a rare gynecologic disorder with only a few documented cases. Because this entity is rarely mentioned in the medical literature, the purpose of this report is to describe such case.

In presented clinical case report 30-year-old woman with polycystic ovary syndrome at the end of first cycle of treatment with combined oral contraceptive, containing ethynilestradiol and dienogest, developed acute cramping hypogastric pain followed by discharge a tissue from vagina. It's histopathological exam was performed with a clear diagnosis of membranous dysmenorrhoea.

Conclusion. The medical knowledge, due to the lack of description of this entity in current textbooks, contributes to its underdiagnosis. More studies are needed to clarify the aetiology and the pathophysiology of this pathologic condition.