Aim. Predicting the selection of euploid embryos based on morphokinetic assessment (KIDScore) of the development of preimplantation embryos using a time-lapse incubator.

Design. A retrospective study.

Materials and methods. 543 human embryos fertilized in vitro and cultured up to the fifth day of development in a time-lapse incubator using KIDScore were studied. Preimplantation genetic testing for aneuploidy (PGT-A) was performed using the Next Generation Sequencing method.

Results. It was found that euploid embryos predominate among the embryos from the oocytes of women under the age of 36 years inclusive. In women 37 years of age and older, the number of aneuploid embryos exceeds the number of euploid ones. Age limits have been established for women (24-36 years old), when it may be reasonable to use the KIDScore assessment to select euploid embryos.

Conclusion. Time-lapse microscopy does not provide an opportunity to identify methodological errors as a result of incorrect chromosome separation, which depends on the age of the mother and leads to an increase in the number of aneuploidies. For embryos from oocytes of women aged 24-36 years, with an increase in the KIDScore score, the chance of choosing a euploid embryo with the highest potential for development also increases. For embryos from oocytes of women 37 years of age and older, culturing in a time-lapse incubator with a KID Score only followed by PGT-A will increase the likelihood of choosing the most viable embryo.

Aim. To identify clinical and anamnestic risk factors for antenatal fetal death (AFD) depending on the gestational age.

Design. Retrospective case — control study.

Materials and methods. The study included 82 patients with AGP and 30 women who gave birth to live children. The participants were stratified into 4 groups depending on the gestational age and pregnancy outcome: Group I — patients with AGP at 22⁰-27⁶ weeks of gestation (n = 26), Group II — patients with AGP at 28⁰-36⁶ weeks of gestation (n = 29), Group III — patients with AGP at 37⁰-41⁶ weeks of gestation (n = 27), Group IV — women who have given birth tolive children. The following parameters were assessed using questionnaires, extracts from individual cards of pregnant and parturient women, birth histories, metabolic and outpatient cards: age, height and weight indicators, menstrual cycle, bad habits before pregnancy, gynecological and extragenital diseases, the time of registration for pregnancy and first trimester screening at 11-13⁶ weeks of gestation were also taken into account.

Results. In patients with AFD at any stage of gestation, weight and body mass index were statistically significantly higher than in women withlive births. Acute respiratory viral infections during pregnancy with fever and asymptomatic bacteriuria were more common in patients with AFD at 22⁰-27⁶ weeks of gestation than participants with live births. Anemia and a history of smoking were more common in two groups of patients with AFD: at 28⁰-36⁶ weeks of gestation and at full term than in women withlive birth. Preeclampsia and umbilical cord abnormalities were additional risk factors for AFD at 37⁰-41⁶ weeks of gestation.

Conclusion. The study of risk factors plays a crucial role in the prediction and prevention of AFD. Awareness of them by women planning pregnancy is of great importance for making informed decisions.

Aim. The aim of the study was improving the possibilities of predicting intrapartum fetal death by conducting a comprehensive assessment of clinical, anamnestic, biochemical and morphological risk factors.

Design. A retrospective cohort study.

Materials and methods. The data of 208 birth histories of patients for 2021-2023 whose pregnancies ended in intrapartum fetal death (155 women — the main group) and 53 histories of patients with uncomplicated pregnancy and childbirth (comparison group) were analyzed. We searched information of family, obstetric-gynecological and somatic anamnesis, the results of the first prenatal screening with an assessment of the functional activity of the trophoblast (в human chorionic gonadotropin and pregnancy-associated plasma protein A). Retrospectively, a point assessment of the degree of perinatal risk was carried out (the scale of perinatal risk factors by V.E. Radzinsky et al., 2018), according to which patients who scored up to 15 points were regarded as belonging to alow degree, from 15 to 24 points — to an average, and above 25 points — to a high degree of perinatal risk). In the postpartum period, a morphological examination of the placenta was performed with macroand microscopic analysis.

Results. In the group of women whose pregnancy was complicated by antenatal fetal death, a combination of preplacental, placental and post-placental risk factors was noted. According to the ROC-curve analysis, with a combination of socio-demographic, somatic, gynecological and gravidary factors, the value of perinatal risk exceeding 9 points increases thelikelihood of antenatal fetal death.

Conclusion. The analysis of clinical and anamnestic data followed by a comprehensive dynamic assessment of risk factors will allow not only the identification of risk groups, but also significantly objectify the prognosis of pregnancy outcomes, timing and methods of delivery. 

Aim. To determine the clinical andlaboratory features of COVID-19 of varying severity during pregnancy.

Design. Prospective cohort study.

Materials and methods. The study included 1476 pregnant women. The main group included 1,386 patients with COVID-19 at various stages of gestation, admitted to the maternity hospital of the Regional Clinical Hospital No. 2 in Chelyabinsk, repurposed into a COVID hospital to provide medical care to pregnant women, women inlabor and postpartum women with COVID-19 , as well as their newborns, in the territory of Chelyabinsk and the Chelyabinsk region, during the 1^st-4^th waves of the COVID-19 pandemic. Depending on the severity of COVID-19, patients of the main group were divided into 4 subgroups: Subgroup 1 — pregnant women with mild COVID-19 (n = 482), Subgroup 2 — women with moderate COVID-19 (n = 718), Subgroup 3 — patients with severe COVID-19 (n = 147), Subgroup 4 — pregnant women with extremely severe COVID-19 (n = 21). The comparison group consisted of 90 women admitted to the maternity hospital of the Regional Clinical Hospital No. 3 in Chelyabinsk from July 2020 to February 2021 in the third trimester of gestation. The comparison group consisted of 90 pregnant women admitted to the maternity hospital of the Regional Clinical Hospital No. 3 in Chelyabinsk from July 2020 to February 2021 in the third trimester of gestation.

Results. The leading symptoms of infection in pregnant women with COVID-19 were fever, general weakness, dry cough with difficult-toseparate phlegm, and shortness of breath. Statistically significantly more often in severe and extremely severe COVID-19 at the time of¹⁵ hospitalization, chest congestion and pain, and rapid heartbeat were noted. Against the background of severe and extremely severe infection, and in comparison with the group of patients without COVID-19,lymphocytopenia, hypoproteinemia, highlevels of band neutrophils, alanine aminotransferase, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), C-reactive protein, ferritin, procalcitonin, soluble fibrin monomer complexes, and D-dimer were statistically significantly more often recorded.

Conclusion. Clinical signs of severe and extremely severe COVID-19 in pregnant women include general weakness, dry cough with difficult-toseparate phlegm, shortness of breath, chest congestion and pain, and rapid heartbeat. Laboratory factors statistically significantly associated with the progression of COVID-19 to extremely severe cases during pregnancy are the highestlevels of AST, LDH, and hypoproteinemia with thelowestlevel of total protein in the blood serum determined at the time of hospitalization. The information obtained will help optimize the prediction of the most unfavorable form of COVID-19 for pregnant women — extremely severe infection.

Aim. The aim of the present study was to evaluate the changes in cytokine factors in cervical secretions after antiviral and immunomodulatory treatment in patients infected with the human papillomavirus (HPV).

Design. Prospective randomized study.

Materials and methods. Fifteen female patients aged 18 to 49 years, infected with HPV of high carcinogenic risk (mainly types 16 and 18), with histologically confirmed severe cervical intraepithelial neoplasia were included in the study. Patients received inosin pranobex orally 1000 mg 3 times a day for 10 days at 10-day intervals for 3 courses and 3,3'-diindolylmethane intravaginally as suppositories 100 mg 2 times a day for 3 months. For all study participants were used the polymerase chain reaction method (PCR) to test HPV and cervical mucus sampling before and after treatment. The content of cytokines in cervical mucus was determined using a commercial Bio-Plex Pro Human Cytokine 27-plex Assay Bio-Plex Pro™ kit manufactured by Bio-Rad Laboratories Inc. (USA) on a Luminex 200 analyzer (Luminex Corporation, USA) according to the manufacturer's recommendations. Ratio of concentrations in cervical mucus of interleukin (IL)-10/IL-17A was calculated as immunoregulatory index IL-10/IL-17A. Correlation analysis was performed between vascular endothelial growth factor (VEGF) and IL-10/ IL-17A. Statistical processing was performed using Excel 365 and SPSS 20.0 software package. Differences were considered statistically significant (the null-hypothesis was rejected) at p < 0.05.

Results. After the therapy in the general group of patients, a decrease in cytokines IL-17A and IL-1ra, chemokines IL-8, interferon—Y inducible protein 10 (IP-10) and monocyte chemotactic protein-1 (MCP-1), as well as growth factors: platelet-derived growth factor BB (PDGF-BB), VEGF and granulocyte-macrophage colony-stimulating factor (G-CSF). Statistically significant decreasing trend after the end of treatment (0.05 < p < 0.1) was found for IL-17A, G-CSF, MCP-1 and PDGF-BB, while the IL-10/IL-17A ratio increased. In a subgroup of 10 patients (62%) with a final negative HPV test, a statistically significant (p < 0.05) decrease in mucus IL-17A, IL-1ra and VEGF was observed. A decreasing trend (0.05 < p < 0.1) was found for G-CSF. In 5 (38%) HPV-positive patients statistically significantly (p < 0.05) decreased the concentrations of IL-8 and VEGF in cervical mucus. There was a tendency to decrease (0.05 < p < 0.1) the MCP-1 content. Withlittle change inlevel of IL-10, the IL-10/IL-17A immunoregulatory index increased after treatment not only in the total group, but also in samples of participants with both negative and positive tests for HPV infection. In addition, treatmentled to a decrease in VEGF and a positive correlation (r = 0.41; p < 0.05) was found between changes in VEGF and IL-17A concentrations.

Conclusion. Complex administration of inosine pranobex orally with 3,3'-diindolylmethane topically have immunomodulatory, anti­inflammatory, antiviral and, possibly, antiangiogenic and antiproliferative effects. Determination of VEGF, IL-10 and IL-17A content in cervical mucus followed by calculation of the immunoregulatory index of IL-10/IL-17A could be useful for prognosis and evaluation of treatment efficacy of HPV-induced cervical mucosal dysplasia.

Aim. To evaluate changes in intracellular processes in reproductive-age patients with intraepithelial lesions against the background of human papillomavirus.

Design. Prospective study.

Materials and methods. This study involved 140 women of reproductive age: the control group included 42 conditionally healthy women without cervical pathology and without human papillomavirus, the main group — 98 patients with cervical pathology (cervical intraepithelial neoplasia II (CIN II), confirmed histologically) and human papillomavirus. All participants were examined in accordance with regulatory documents, and to achieve the stated goal — study and analysis of apoptotic fluctuations in the cervix — levels of apoptosis markers in CIN II (caspases 3, 8 and 9), as well as human papillomavirus.

Results. All test parameters significantly differed from one another: caspase 3 levels significantly differed from caspase 9 and 8 levels, while caspase 8 and 9 levels significantly differed from one another as well as within each group and when study groups were compared with one another: apoptotic indices were significantly higher in patients with CIN II against the background of HPV. At the next stage, all patients in the group with viral load were randomly divided into subgroups: subgroup A — 49 patients who underwent only surgical treatment of CIN II, and subgroup B — 49 patients who were prescribed surgical treatment of CIN II and drug therapy. The studied parameters measured 3, 9 and 12 months after the start of the work differed significantly from each other, significantly differed from the values of the control group and the baseline indices. The minimum values were achieved only after 12 months in subgroup B, while in patients of subgroup A, caspase concentrations after 3 and 9 months also decreased, but not as rapidly as in the subgroup with complex treatment. It should be noted that after 12 months, the values of the studied caspase 8 and caspase 9 within the subgroup with one stage of treatment began to have a tendency to increase. In subgroup A, the maximum treatment effect was achieved after 9 months of observation in 80% of the subjects, and in subgroup B, a decrease in viral load less than clinically significant was recorded in 94% of participants after 3 months, in 86% after 9 and in 84% after 1 year.

Conclusion. The obtained results of the study emphasize the need for an expanded approach to the treatment of patients with viral load and moderate neoplasia, which should include both the surgical stage and the use of approved drugs with antiviral activity. This approach is more successful and will ensure delayed favorable treatment results.

Aim. To establish the nature of psychovegetative and hemodynamic reactions, to assess clinical symptoms of pelvic floor dysfunction, to optimize diagnostic search and to determine the tactics of managing patients with pelvic pain syndrome and dysuria.

Design. A prospective study.

Materials and methods. The study involved 244 women of reproductive age with complaints of pain in the pelvic area and dysuria with a disease duration of more than 6 months, including 141 patients with chronic pelvic pain (CPP) and dysuria, 103 — only with dysuria. The control group consisted of 35 conditionally healthy women. The patients underwent laboratory and bacteriological diagnostics, pelvic sonography, urethrocystoscopy. To objectify the pain intensity, a digital rating scale, the DN4 neuropathic pain questionnaire were used, and to assess dysuria, — urination diaries, and the International Prostate Symptom Score (IPSS) questionnaire were used.

Results. Women with CPP and dysuria had longer and more frequent exacerbations of the disease, the presence of symptoms during remission, and the absence of a clear connection with provoking factors (p < 0.001). In addition to pain and dysuria, patients complained mainly of rapid fatigue, sleep disturbances, and irritability. During treatment, special attention was paid to the correction of pelvic floor muscle syndromes, hemodynamic disorders, autonomic nervous system functioning, and psychoemotional state. Complex therapy was used with an emphasis on pelvic muscle relaxation methods. Positive dynamics were noted in 87.2% of women with CPP and dysuria and in 90.3% with dysuria only. The patients had a decrease in the number of urinations and imperative urges, episodes of urgent incontinence. The severity of urination disorders according to the IPSS scale decreased in patients with pelvic pain and dysuria and amounted to 6.5 ± 2.1 and 8.8 ± 2.7 points, in patients with dysuria only — 4.9 ± 1.3 and 5.9 ± 1.6 points (p < 0.001), which corresponded to mild and moderate disorders.

Conclusion. An integrated approach to the diagnosis and therapy of this category of patients allows to optimize treatment and achieve greater effectiveness, and also helps to improve the quality of life of women.

Aim. To identify the features of the metabolomic profile in women with gestational diabetes mellitus (GDM).

Design. A single-center observational study based on the "case — control" design.

Materials and methods. The main group included 24 patients with GDM, while the control group consisted of 21 pregnant women without GDM. The concentrations of 26 amino acids in morning urine samples were studied in all patients. The amino acid content determination was performed at Chromolab LLC using an HPLC Agilent 1200 chromatographic system. Statistical analysis of the obtained data was carried out using IBM SPSS v. 26 software.

Results. Analysis of the metabolomic profile revealed reduced total urinary amino acid content in the presence of GDM: in the main group, this indicator was 931.5 (6581020.6), in the control group — 1197.4 (710.9-1290.8) mmol/mol creatinine, however, no statistically significant differences were found (p = 0.09). The concentrations of most amino acids in the main group were decreased, but compared to the control group, it showed slightly higher levels of glutamic acid, serine, ornithine, citrulline, and gamma-aminobutyric acid (p > 0.05). However, statistically significant differences were found between the study groups in the concentrationlevels of three amino acids: valine, lysine, and glutamine.

Conclusion. Enabling the measurement of thousands of metabolites in complex biological systems, particularly in the human body, metabolomics is becoming a widely used method for biomarker identification and in research related to GDM. Metabolites in urine can become biomarkers of GDM and provide further understanding of the etiology and pathophysiology of this disease.

Aim. A review of scientific literature data on vaccination of patients at the preconception stage and during pregnancy, the effect of the domestic vaccine against COVID-19 on the development of obstetric and perinatal complications, as well as a study of the dynamics of vaccination in the regions of the Russian Federation.

Key points. The problem of vaccinating pregnant patients, as well as women planning pregnancy, against a new coronavirus infection is extremely relevant in connection with the recent COVID-19 pandemic and its negative impact on public health. Women during pregnancy and the postpartum period are at high risk of severe disease and the development of obstetric and perinatal complications. In addition, a new coronavirus infection suffered before pregnancy may lead to an increased risk of gestational complications. Despite recommendations from leading world and Russian medical organizations about the need to vaccinate pregnant women who are at highest risk of severe COVID-19, the proportion of vaccinated patients remains insignificant. An obstacle to widespread vaccination in the pregnant population is a lack of information and misinformation about the risks associated with vaccination in relation to the health of the mother and fetus. Vaccination coverage among pregnant women in the Russian Federation is insufficient to achieve herd immunity.

Conclusion. Vaccination against the new coronavirus infection is an effective method of preventing severe COVID-19, obstetric and perinatal complications and does not have a negative impact on the mother’s health. However, in the modern scientific literature there is insufficient data on the impact of vaccination against COVID-19 on the course of pregnancy, the health of the fetus and newborn, so these issues remain relevant and require further research.

Aim. Analysis of the effectiveness and safety of local terminal anesthesia in gynecological practice using the example of two clinical observations.

Key points. Local terminal anesthesia is an effective and safe method of anesthesia, widely used in modern gynecological practice in the performance of 

various diagnostic and therapeutic manipulations. This method involves the application of local anesthetic directly into the area of intervention, which allows to achieve an adequate level of anesthesia without general anesthesia. This strategy has several advantages, including the absence of the need for complex preoperative preparation, low risk of serious complications associated with general anesthesia, and a significant reduction in recovery time after the procedure. The effectiveness of local terminal anesthesia is due to the selective action of the anesthetic on the nerve endings in the area of application, which provides a temporary loss of sensation in the treated area. The described clinical observations confirm the possibility of safe and effective use of local terminal anesthesia in gynecological practice.

Conclusion. The use of local terminal anesthesia provides effective anesthesia with minimal risk of complications, decreased recovery time and preservation of the patient's consciousness, which makes this method preferable for many outpatient procedures.

Aim. To systematize the data available in the literature on the etiology, diagnosis, and treatment of hyperandrogenism syndrome in postmenopausal women.

Key points. Hyperandrogenism in postmenopause represents a clinical problem that is often overlooked due to the misconception that hyperandrogenic conditions are rare after menopause. This review examines the etiology, diagnosis, and treatment of androgen excess in postmenopausal women, as well as diagnostic and therapeutic approaches.

Conclusion. Hyperandrogenism in postmenopause represents a complex clinical problem that requires careful differential diagnosis and an individualized approach to treatment to ensure optimal patient management and improve quality of their life.

Aim. To demonstrate the advantages of an innovative optical-electron method of cervical cancer screening.

Key points. Despite all measures for early diagnosis and prevention of cervical cancer, the morbidity and mortality rates are still high, and there is a tendency to increase the incidence of this formidable pathology with visually located tumors. Since 1980 the optical-electronic method of cervical cancer screening has been officially registered. Since the beginning of the use of the device for diagnostic purposes, numerous international studies have been conducted, in which it has been proved that the sensitivity of the TruScreen optoelectronic cervical cancer screening is not inferior to that of liquid cytology, and in terms of specificity in some cases it even surpasses the routine screening method. TruScreen is only slightly inferior to human papillomavirus (HPV) testing in terms of sensitivity, while HPV tests show significantly lower results in terms of specificity due to the transient nature of the infection and, in some cases, self-cure. TruScreen reduces misdiagnoses of cervical intraepithelial neoplasia (CIN) and effectively predicts the absence of CIN in women with cervical transformation zone types II and III, thereby reducing the incidence of endocervical curettage.

Conclusion. Optical-electronic technology should rightfully take its place in the diagnosis of precancerous and cancerous diseases of the cervix. The rapidity of response and painlessness of the method will make patients more committed to medical check-ups and preventive examinations. Optoelectronic technology can be indispensable in the absence oflaboratory infrastructure. The mobility and ease of use will attract nurses and general practitioners to maximize the coverage of the female population with dispensary and preventive examinations. 

Aim. To evaluate current approaches to the treatment of vomiting in pregnant based on modern clinical guidelines.

Key points. Nausea, vomiting, decreased appetite and changes in taste sensations are frequent companions of pregnancy. Such disorders occur in 80-90% of women. In most cases, they do not require medical intervention. However, some patients develop severe vomiting (hyperemesis gravidarum). This condition is dangerous for both the mother and the fetus, so it requires active treatment.

Conclusion. The analysis of Russian and international approaches to the treatment of vomiting in pregnant women shows adherence to uniform principles of therapy and good consistency in the recommendations for choosing treatment based on the principle of safety, stepby-step and individualization.

Aim. To systematize data on optimal forms of delivery of the resveratrol molecule, its dosages, bioavailability, combined regimens and possible side effects when used to slow down aging in women during the menopausal transition.

Key points. Every year in the Russian Federation, more than 1 million women enter menopause. Climacteric syndrome as a complex of vasomotor, psychoemotional, musculoskeletal disorders due to estrogen deficiencyleads to a decrease in the quality oflife of women over 40 years old. Within the framework of the review article, an assessment of modern non-hormonal methods for correcting climacteric syndrome was carried out. Among the new generation of phytoestrogens, trans-resveratrol stands out significantly; we considered the multitarget properties of the molecule from the standpoint of slowing down aging.

Conclusion. The use of phytoestrogens has wide possibilities in personalized menopausal phytotherapy, the strategy of increasing the bioavailability of new phytotherapy technologies is able to influence estrogen-deficient conditions of women with greater efficiency. Trans­resveratrol in sublingual form is a unique solution for the correction of climacteric syndrome due to its high bioavailability, in this form it bypassesliver metabolism. The ability of trans-resveratrol to modulate estrogen-dependent pathways, suppress oxidative stress and systemic inflammation allows to effectively reduce the severity of vasomotor symptoms, improve cognitive functions and slow down involutional processes. Sublingual administration ensures rapid achievement of therapeutic concentrations and potentiates geroprotective effects, which makes this form of the drug promising for complex anti-aging therapy in women in menopause.

Aim. To present the experience of usinglaser vascular coagulation for the treatment of non-immune hydrops fetalis associated with placental chorioangioma.

Key points. A series of clinical cases of pregnant women with placental chorioangioma and non-immune hydrops fetalis with varying pregnancy outcomes is described. The experience of managing this complication through intrauterine intervention — laser vascular coagulation — is demonstrated.

Conclusion. Timely surgical treatment with intrauterinelaser coagulation of vessels supplying the chorioangioma can resolve fetal hydrops and enable subsequent term delivery.