Despite their rarity, trophoblastic tumors are an important obstetric problem due to the high risk of severe complications in both the mother and fetus. Trophoblastic disease, including its benign and malignant manifestations, most often affects young women at an age when their social life is most active and their reproductive function is at its peak. This circumstance underscores the importance and urgency of finding effective treatments for this pathology, as well as preserving the reproductive health of patients. Hydatidiform mole is a benign variant of trophoblastic disease. In addition, it poses a serious threat in early pregnancy, as it can be asymptomatic in the first two months of gestation, which in turn creates significant difficulties for its timely diagnosis. The article describes a rare clinical case of pregnancy and delivery of a healthy live fetus with a partial hydatidiform mole, as well as the features of pregnancy and postpartum management. The patient’s pregnancy was accompanied by ovarian hyperstimulation, threatened miscarriage, and premature labor, with bilateral giant theca lutein cysts being formed. The cysts form in the ovaries due to high levels of human chorionic gonadotropin and prolactin. The pregnancy outcome was favorable.
Background: Recurrent implantation failure occupies a central place among the unresolved challenges of contemporary reproductive medicine, occurring in 15–20% of women undergoing in vitro fertilization treatment. Despite the implementation of preimplantation genetic testing for aneuploidy, which allows for the embryonic factor to be excluded, the pregnancy rate following euploid embryo transfer in patients with recurrent implantation failure remains substantially lower than in fertile women. Effective methods for correcting endometrial dysfunction in this patient population are still absent from clinical guidelines. Aim: The aim of this study was to compare, in patients with recurrent implantation failure, the efficacy of two regenerative medicine approaches (intrauterine perfusion of platelet rich plasma and subcutaneous administration of granulocyte colony stimulating factor) in frozen–thawed euploid embryo transfer cycles. Methods: This randomized controlled trial was conducted involving patients with recurrent implantation failure and confirmed euploid embryos. Four groups of 47 patients each were formed: Group 1 received intrauterine perfusion of 1 ml of autologous platelet rich plasma on days 10–11 of the menstrual cycle; Group 2 received subcutaneous injections of 300 μg of recombinant human granulocyte colony stimulating factor (filgrastim) daily for 3 consecutive days, starting on the day of embryo transfer; Group 3 underwent standard endometrial preparation without any regenerative intervention; and the control group consisted of gestational surrogates (fertile women) who received an identical hormonal preparation protocol. The primary outcome was the clinical pregnancy rate, defined as visualization of a gestational sac on transvaginal ultrasound at 6–7 weeks. Secondary outcomes included the live birth rate, the miscarriage rate up to 12 weeks of gestation, and endometrial thickness. Results: The clinical pregnancy rates in Groups 1, 2, 3, and the control group differed significantly: 63.8% (30/47), 48.9% (23/47), 27.7% (13/47), and 68.1% (32/47), respectively. Group 1 demonstrated a significant superiority over Groups 2 and 3 (p 0.010), while the difference versus the control group did not reach significance (p 0.050). The live birth rates were 55.3% (26/47) in Group 1, 40.4% (19/47) in Group 2, 21.3% (10/47) in Group 3, and 61.7% (29/47) in the control group, with significant differences identified between Group 1 and Groups 2 and 3 (p 0.010). Factor analysis demonstrated that patient age, endometrial thickness, and the absence of chronic endometritis are independent predictors of clinical pregnancy and live birth. Conclusion: Intrauterine perfusion of platelet rich plasma is a highly effective method for increasing the clinical pregnancy and live birth rates in patients with recurrent implantation failure, yielding outcomes comparable to those achieved in fertile women.
BACKGROUND: Endometriosis is the third most common gynecological disease. The disruption of the cellular and cytokine-mediated mechanisms underlying the course of this pathology remains poorly understood. AIM: The aim of this study was to evaluate blood serum and peritoneal fluid cytokine levels at various stages of endometriosis in women of reproductive age. METHODS: This case-control study included patients aged 17–25 years who were diagnosed with endometriosis stages I–II (Group I) and stages III–IV (Group II). The comparison group included apparently healthy women. Blood serum and peritoneal fluid levels of tumor necrosis factor-alpha, transforming growth factor-beta, and interleukins IL-13 and IL-23 were determined by enzyme-linked immunosorbent assay using reagents manufactured in the USA. RESULTS: The study included 77 women. Group I consisted of 22 patients, and Group II of 25 patients. The comparison group comprised 30 apparently healthy women. The most significant changes in the blood serum of patients in Group I were observed in IL-23 level, which was increased by 2.65 times compared to the comparison group. In patients in Group II with endometriosis stages III–IV, the most significant changes in the peritoneal fluid were observed in tumor necrosis factor-alpha level, which was increased by 3.2 times compared to the comparison group. In contrast, IL-13 level dropped sharply in both peritoneal fluid and blood serum (on average, by 63% compared to the comparison group). CONCLUSION: The identified general patterns and characteristics of regulatory responses in endometriosis expand our understanding of the mechanisms of disease development and treatment prospects.
BACKGROUND: Late intrauterine fetal death is the dominant cause of perinatal mortality in developed economies. Despite progress in reducing neonatal mortality, the incidence of stillbirths has stagnated over the past decades. Morphological examination of the placenta, which provides a wealth of diagnostic information, has the potential of in-depth insight into the pathophysiological mechanisms that underlie adverse pregnancy outcomes, including late intrauterine fetal death. AIM: The aim of this study was to assess the relationship between different types of placental inflammation and fetal death before 28 weeks of gestation. METHODS: This case-control study included patients with intrauterine fetal death at 22+0–27+6 weeks of gestation (main group) and with a live birth (control group). Morphological examination of the placentas was performed using the standard technique of formalin fixation, alcohol dehydration, and paraffin embedding. Sections approximately 6–8 µm thick were prepared for hematoxylin and eosin staining. For morphological examination, 12 placental samples were prepared (material was collected from the central, paracentral, and peripheral zones, with 4 samples from each zone). Inflammatory changes were determined, expressed as characteristic cellular infiltration of various placental structures, namely, the chorionic plate, basal and parietal decidua, amnion, and villous stroma. RESULTS: The study included 97 patients, of which 36 women formed the main group and 61 women formed the control group. Inflammation of any localization was 2.4 times more common in the group with late intrauterine fetal death compared to the control group (p = 0.004). Chorioamnionitis, intervillitis, and villitis were 3.7 (p = 0.001), 2.75 (p = 0.003), and 4.5 times (p = 0.02) more common in the stillbirth group, respectively. In the group of women who delivered a live infant, placental inflammation was more often associated with the presence of pathogens than in the group with late intrauterine fetal death (p = 0.003). In patients with stillbirth, the presence of microorganisms in bacterial cultures from the cervical canal was associated with three or more microorganisms in quantities greater than 105 CFU/ml. The leading microorganisms were Staphylococcus aureus, Escherichia coli, Acinetobacter Baumannii, Enterococcus faecalis, Staphylococcus haemolyticus, and Proteus vulgaris. Inflammatory reactions, with the exception of funisitis, were observed more frequently in the placentas of women in the main group. CONCLUSION: The increased frequency of inflammatory placental lesions in stillbirths suggests that inflammation may play a key role in the etiology of intrauterine fetal death before 28 weeks of gestation.
Background: Pelvic organ prolapse is a problem faced by most women over 45 years of age. It can cause discomfort and pain, and negatively affect the quality of life. In patients of reproductive age, severe rectocele is combined with apical prolapse, and these patients require immediate simultaneous closure of rectovaginal fascia defects and correction of the uterosacral and cardinal ligament complex. Aim: The aim of this study was to evaluate the effectiveness of one-stage correction of apical-rectal prolapse by replacing the uterosacral and cardinal ligament complex with a synthetic implant and closing rectovaginal fascia defects by forming native neofascia. Methods: The study included 107 patients of reproductive age with apical-rectal prolapse, who underwent surgical correction of pelvic organ prolapse by replacing the uterosacral and cardinal ligament complex with a synthetic implant and closing the defects by forming native neofascia. The preoperative examination included a collection of complaints, a personal medical history, a physical and gynecological examination, electromyography of the pelvic floor muscles and anal sphincter, and defecography. The impact of the disease on quality of life was assessed using the Pelvic Floor Impact Questionnaire (PFIQ-7), which was completed by patients before surgery. In the postoperative period, examinations were carried out after 3, 9 and 12 months and then annually thereafter. Results: The average age of the patients was 38.36 ± 5.07 years, with body mass index of 27.32 ± 4.17 kg/m2. History of childbirth was 1.86 ± 0.74. The average duration of the operation was 48.4 ± 19.6 minutes, the volume of intraoperative blood loss was 50 ± 90 ml, the length of hospital stay was 4.2 ± 0.7 bed days (maximum 7). Anatomical recovery efficiency, assessed according to the Pelvic Organ Prolapse Quantification (POP-Q) System, was 91.6%. Average POP-Q values (D, C, Ap, Bp) were –8.1 ± 0.7, –7.1 ± 0.6, –2.0 ± 0.7, and –2.6 ± 0.6, respectively. An assessment of patient satisfaction with the surgical results showed that 96.0% of patients were satisfied and would recommend this intervention to their relatives and friends. According to the PFIQ-7 questionnaire, the total score decreased from 130 [100; 168] to 46 [28; 74] by 12 months (p 0.001; Wilcoxon test). Conclusion: Surgical reconstruction of the pelvic floor in stage III–IV apical-rectal prolapse by means of prosthetic replacement of the uterosacral and cardinal ligament complex with a synthetic implant and closure of rectovaginal fascia defects by forming native neofascia is a safe technique that provides high anatomical and functional efficiency, and improves patients’ quality of life.
Chronic endometritis (CE) is a common pathology among women of reproductive age, which negatively affects health, fertility and quality of life. Clinical guidelines for its treatment have not yet been developed either abroad or in the Russian Federation, and therefore a unified algorithm for the management of patients with CE is lacking. Current literature offers a wide variety of treatment methods, including a two-stage approach. At the same time, the primary and fundamental stage of CE treatment is the use of antibacterial and anti-inflammatory therapy, as the disease is considered to be infectious. However, this approach to CE treatment, with its emphasis on antibacterial therapy, does not always resolve issues associated with reproductive failure and menstrual irregularities (MI). It has been suggested that treatment failure may be related to the ambiguity of the exclusively infectious etiology of chronic endometrial inflammation (CEI). This review article addresses the study, analysis, and generalisation of the world literature on CE treatment, utilizing publications from open electronic databases such as Google Scholar, PubMed, eLIBRARY, and CyberLeninka over the past 8 years. In overcoming the infectious factor in the genesis of implantation failure and MI, modern therapy aimed at elimination of pathogens does not always lead to the desired result (restoration of fertility and morphological characteristics of the endometrium). Such cases require extended clinical examination of patients to be consulted further by specialists of related fields to identify diseases / conditions that contribute to the development of CEI. Given the variety of factors that may contribute to this, patients who do not respond to conventional treatment (no clinical and pathomorphological effects) require more in-depth pre-treatment evaluation with the selection of personalised therapy. The search for new therapeutic methods is ongoing to improve treatment outcomes.
Background: Asthma is traditionally considered as a risk factor for obstetric and perinatal complications, such as preterm birth (PB), fetal growth restriction, small for gestational age and low birth weight (LBW) infants. The safety of asthma drug therapy during pregnancy is not fully established. Contradictions in the literature, the breadth of the medical and social significance of the issue, and the desire to improve public health prompted an analysis of perinatal outcomes in pregnant women with asthma in St. Petersburg, Russia. Aim: The aim of this study was to analyze perinatal outcomes of pregnancies complicated by maternal asthma, depending on the severity of the disease, the presence of exacerbations, and the type of therapy administered. Methods: This retrospective analysis of 2637 singleton deliveries that occurred between January 2002 and December 2024 in St. Petersburg, Russia among patients with asthma was conducted including 1047 patients with mild intermittent asthma, 893 with mild persistent asthma, 628 with moderate persistent asthma, and 69 patients with severe asthma. Results: The average birth weight of full-term infants was inversely correlated with the severity of asthma during pregnancy (p = 0.00054). In cases of severe asthma, the relative risk (RR) of delivering full-term newborns with a birth weight in the range from 3 to 9‰ at term was 6.06 [95% confidence interval (CI) 3.3–11.2], and for LBW infants, RR was 3.76 [95% CI 2.0–6.9]. The PB rate was 3.8% and did not depend on the severity of asthma. Asthma exacerbations were observed in 47.4% of the cohort overall, and were associated with LBW — RR 1.51 [95% CI 1.05–2.2]. A total of 81.8% of pregnant women with persistent asthma received treatment with inhaled corticosteroids (ICS) combined with short-acting (SABA) or long-acting (LABA) β2-agonists. Most patients received fixed-dose combinations of ICS with LABA: budesonide / formoterol (n = 586) and fluticasone / salmeterol (n = 268). Infants whose mothers were treated with ICS+LABA had higher birth weights, both among full-term newborns (p = 0.002) and in the overall study group (p = 0.019). Treatment with ICS + LABA was not associated with an increased RR of PB, LBW infants, or infants with birth weights in the range from 3 to 9‰ and less than 3‰ at the gestational age. Conclusion: This study confirms the necessity of regular clinical follow-up for pregnant women with asthma, prevention of asthma exacerbations, and adequate therapeutic interventions. Management of modifiable risk factors for exacerbations is crucial, including behavioral aspects such as treatment adherence, anxiety or depression. Improving patient awareness contributes to better health outcomes in children in cases of maternal asthma.
BACKGROUND: Cervical cancer is a leading cause of death in women worldwide. The primary driver of its development is the human papillomavirus (HPV). In women infected with HIV, the prevalence of HPV and, consequently, the incidence of HPV-associated lesions of the cervix and vagina, is higher than in the general population. To prevent these diseases, it is important to understand the factors that increase the risk of HPV infection. AIM: The aim of this study was to assess the risk factors for HPV infection in women with different HIV status living in St. Petersburg, Russia. METHODS: This case-control included 100 HIV-infected women (main group) and 100 HIV-negative women (control group) living in St. Petersburg, Russia. Polymerase chain reaction was used to determine the DNA of 21 HPV types, plasma HIV RNA, and CD4+ lymphocyte counts in vaginal and cervical secretions. The clinical and epidemiological characteristics were examined. RESULTS: The frequency of HPV detection in the vagina and cervical canal was 55% in HIV-infected women and 32% in HIV-negative women. In patients with HIV, the presence of HPV was associated with such clinical characteristics as the duration of HIV infection, the duration of antiretroviral therapy, HIV RNA levels, and CD4+ lymphocyte count. HPV was most frequently detected in the first year after HIV diagnosis, and then the probability of HPV detection decreased almost tenfold as the duration of the disease increased. With a one-year increase in the duration of antiretroviral therapy, the probability of HPV detection in the cervical canal decreased by 1.14 times, and when HIV RNA levels in the blood were 40 copies/ml, HPV prevalence increased by 4.71 times. In the control group, the main risk factors for HPV infection were smoking, the onset of sexual activity before the age of 18, and a large lifetime number of sexual partners. CONCLUSION: In HIV-positive women, HPV prevalence is influenced by the following clinical characteristics: detectable HIV viral load and immunodeficiency increase the risk of HPV detection, while the use of antiretroviral therapy reduces the risk of HPV infection.
BACKGROUND: Maternal hyperhomocysteinemia is commonly regarded as a marker of folate deficiency. However, there is ample evidence to designate this condition as an additional risk factor for obstetric complications, which requires a separate approach to conducting clinical and preclinical studies, and accordingly, to selecting an experimental model for in vivo research. The mechanisms underlying the negative impact of homocysteine and its metabolites on the placenta remain poorly understood. Of interest is the investigation of signaling pathways linking hyperhomocysteinemia to the development of oxidative stress and altered angiogenesis, which leads to insufficient blood flow and placental dysfunction. AIM: The aim of this study was to evaluate oxidative stress and activation of intracellular signaling pathways in the placenta in experimental methionine-induced hyperhomocysteinemia. METHODS: A randomized clinical trial was conducted. Hyperhomocysteinemia in female Wistar rats was induced by daily oral administration of methionine (0.6 g/kg body weight) from day 4 of pregnancy until the material was collected. On days 14 and 20 of pregnancy, the placenta was assessed for oxidative stress parameters, the levels of nuclear factor erythroid 2-related factor 2 (NRF2), tumor protein p53, signal transducer and activator of transcription 3 (STAT3), the activation of p38 mitogen-activated protein kinase (p38 MAPK), and apoptosis-inducing factor (AIF) expression levels. RESULTS: In methionine-induced hyperhomocysteinemia in pregnant rats, the placenta showed an increase in malondialdehyde levels on days 14 and 20 of pregnancy, without changes in catalase activity and antiradical activity. On day 14 of pregnancy, hyperhomocysteinemia in the rat placenta revealed no changes in NRF2, STAT3 and p53 leveles, or the phospho-p38/p38 MAPK ratio. However, on day 20, a decrease in NRF2 levels and an increase in p53 and AIF levels, and the phospho-p38/p38 MAPK ratio were observed. CONCLUSION: The data obtained suggest that increased oxidative stress associated with hyperhomocysteinemia activates signaling pathways in the placenta, including those related to cell death regulation. This may cause disruptions in angiogenesis, leading to adverse pregnancy outcomes.
Background: Despite the development of minimally invasive technologies, the optimal approach for hysterectomy in obese patients remains a subject of debate. The comparative effectiveness of the new vaginal natural orifice transluminal endoscopic surgery (vNOTES) method and robot-assisted surgery in this patient group has been insufficiently studied. Aim: The aim of this study was to compare the effectiveness of hysterectomy using the vNOTES method and robot-assisted hysterectomy in obese patients with gynecological diseases. Methods: This prospective study included patients with a body mass index (BMI) 30 kg/m2 who underwent hysterectomy for benign conditions. In group 1 (n = 45), hysterectomy was performed using the vNOTES method with prior traditional ligation of the cardinal and uterosacral ligaments. In group 2 (n = 45), hysterectomy was performed using the vNOTES method with the LigaSure device for transecting the cardinal and uterosacral ligaments. In group 3 (n = 80), robot-assisted hysterectomy was performed. Surgery duration and blood loss volume were assessed. Statistical analysis was performed using the Kruskal–Wallis, Mann–Whitney, and Fisher’s exact tests. Results: The mean age of the patients was 57±8.5 years. BMI was highest in the robot-assisted surgery group (36.9±6.7 kg/m2). The median surgery duration was shortest in the vNOTES with LigaSure group — 90 [75; 110] min, which was shorter than in the traditional vNOTES group — 110 [95; 125] min and robot-assisted access group — 115 [90; 150] min, p 0.009. The lowest blood loss was recorded in the robot-assisted hysterectomy group — a median of 70 [50; 100] ml, which was lower than the values for vNOTES with LigaSure — 150 [100; 180] ml and traditional vNOTES — 180 [150; 250] ml, p 0.0001. Conclusion: The conducted analysis demonstrates that vNOTES hysterectomy using the LigaSure device ensures the shortest operative time, while robot-assisted hysterectomy results in minimal blood loss. The choice of the optimal method in obese patients should be made individually, taking into account the clinical situation and technology availability.
The greater vestibular glands of the vagina were described in the 17th century by the Danish anatomist Caspar Bartholin the Younger. In his honor, the glands received their second name — Bartholin’s glands (BG). Obstetricians and gynecologists more often encounter retention and inflammatory lesions of the BG in their routine clinical practice. Furthermore, different types of BG epithelium can be a source of malignant tumors characterized by varying clinical courses. The following malignant BG tumors have been described in the literature: transitional cell carcinoma, neuroendocrine carcinoma, adenocarcinoma, adenosquamous carcinoma, adenoid cystic carcinoma, leiomyosarcoma, and epithelial-myoepithelial carcinoma. The diagnostic criteria for primary BG carcinoma were proposed in 1972 by Dikran L. Chamlian and Herbert B. Taylor and remain valid today: the tumor is located in the BG region and originates from cellular elements characteristic of the region; areas of clear transition from normal vulvar tissue to tumor elements are identified; there are no signs that the tumor is a metastasis from a primary tumor in another location. Malignant vulvar tumors, according to available literature, account for 3% to 5% of all vulvar carcinomas. Despite the rarity of malignant BG diseases, they constitute the majority of vulvar adenocarcinomas. Data on malignant BG tumors in the literature are presented very sparingly, mainly in the form of case reports or small series. This article describes four clinical cases of primary malignant BG tumors. All four patients were treated in the Department of Gynecologic Oncology, the N.N. Petrov National Medical Research Center of Oncology from 2019 to 2025. Two cases of HPV-associated squamous cell carcinoma, one of adenocarcinoma, and one of myoepithelial adenocarcinoma are reported. The authors present the signs and symptoms, clinical course, treatment outcomes, and recurrences of the malignant BG tumors with varying histopathologies. Malignant BG tumors can be cured with a high probability in case of early diagnosis and adequate combined treatment, including surgical removal of the tumor, radiation therapy, and polychemotherapy.
This literature review surveys scholarly articles relevant to rare vulvar diseases associated with the presence of ectopic breast tissue in the anogenital region. Because it is morphologically similar to mammary tissue, with its structure occupying an intermediate position between eccrine and apocrine glands, they are termed anogenital mammary-like glands. Most of the literature describing pathological changes in these glands are case reports or small case series. We analyzed 121 clinical cases of medical consultations regarding tumors and tumor-like masses developing from anogenital mammary-like glands. In 8.3% of cases, the tumor consisted of unchanged tissue of the anogenital mammary-like glands. Lactation-related changes in anogenital mammary-like glands during pregnancy or after childbirth were the reason for seeking medical attention in 19.2% of cases. Benign diseases of the anogenital mammary-like glands were detected in 36.7% of cases. These included fibroadenoma, benign phyllodes tumor, papillary hidradenoma, adenoma, fibrocystic breast changes, papillary apocrine fibroadenoma, and benign ductal hyperplasia with adenosis. Malignant tumors of the anogenital mammary-like glands accounted for 35.8% of cases. Histological examination revealed carcinoma, adenocarcinoma, and Paget’s disease. Treatment options depended on the type of malignancy, its receptor status, tumor size and extent of the pathological process, as well as the patient’s age, general health, preferences, and the presence of comorbidities.
BACKGROUND: Early-onset preeclampsia in multifetal pregnancy is a major clinical challenge associated with high maternal and perinatal morbidity and mortality. Its pathogenesis is complex and is thought to arise from interactions between genetic susceptibility and environmental factors, with oxidative stress representing a key mechanistic component. Although the genetic basis of oxidative stress has been investigated in a number of domestic and international research centers, comprehensive studies that integrate the epistatic interactions between genes and their relationship to oxidative status in patients with multifetal pregnancy remain scarce. AIM: The aim of this study was to assess the frequency of polymorphic variants in genes involved in hemostasis and folate metabolism, identify significant epistatic interactions, and evaluate oxidative status markers in patients with multifetal pregnancy complicated by early-onset preeclampsia. METHODS: This single-center case-control study included patients with multifetal pregnancy, with or without preeclampsia. Genotyping of 12 single nucleotide variants in hemostasis related genes (F2, F5, F7, F13, FGB, ITGA2, ITGB3, SERPINE1) and folate cycle genes (MTHFR, MTRR, MTR) was performed using real-time polymerase chain reaction. Oxidative status was assessed by total antioxidant capacity, lipid peroxidation index (PerOx), and the integral oxidative stress index (OxyStat). Epistasis was explored using the generalized multifactor dimensionality reduction (GMDR) method. RESULTS: The study included 157 women (main group: 38 women with early-onset preeclampsia; control group: 119 women without preeclampsia). The carriage of minor alleles in the SERPINE1 −6755G4G, ITGA2 807CT, and MTRR 66AG gene variants was associated with an increased risk of early-onset preeclampsia in multifetal pregnancy. The GMDR method identified significant epistatic interactions; the most predictive three-locus model (ITGA2 + SERPINE1 + MTRR genes) achieved a balanced accuracy of 0.8902 with a sensitivity of 97.5%. Patients with preeclampsia exhibited a marked oxidative imbalance, with a 4.2-fold decrease in total antioxidant capacity and nearly 3-fold increases in PerOx and OxyStat compared to control values. The carriage of the SERPINE1 4G allele and the ITGA2 T allele was associated with more pronounced impairment of oxidative status. CONCLUSION: The data obtained support a plausible pathogenic link between genetic susceptibility and oxidative stress in early-onset preeclampsia in multifetal pregnancy. Unfavorable genotype combinations in the SERPINE1, ITGA2, and MTRR genes may confer a high genetic risk that, in the context of multifetal gestation, is realized through hypercoagulability, endothelial dysfunction, and placental ischemia-reperfusion, culminating in severe oxidative stress and clinical manifestation of preeclampsia. The results substantiate the rationale for a comprehensive risk stratification approach integrating genetic testing and oxidative status assessment.
Background: Timely diagnosis of adenomyosis remains important due to the high incidence of the disease among women of reproductive age. Interest in using myometrial transition zone parameters in diagnostic algorithms has persisted since the first data on it as a marker for adenomyosis emerged. However, the role and clinical significance of the junctional zone in patients with adenomyosis currently remain a subject of scientific debate due to the inconsistency of the available data. Furthermore, the literature lacks information on its dynamics and changes under the influence of various therapies. Aim: The aim of this study was to evaluate the diagnostic significance of the junctional zone parameters in adenomyosis and their changes during the treatment of the disease. Methods: A prospective cross-sectional, single-center study was conducted. All patients underwent ultrasound examination using an expert-class GE Voluson E10 (GE Healthcare, USA) with IC5-9-D and RIC6-12-D probes, color Doppler mapping, elastography, and volume reconstruction. To diagnose adenomyosis, we used the results of a comprehensive ultrasound examination using a patented proprietary scoring method. All patients underwent a junctional zone assessment. Results: 344 women were examined: 287 with a diagnosis of adenomyosis, of whom 273 had complaints and 14 were without complaints, and 57 patients in the control group. Significant differences were found in the assessment of the junctional zone in the main groups and the control group (p = 0.37). In 156 patients, the junctional zone was assessed before and 6 months after treatment of adenomyosis using several regimens: resveratrol 100 mg daily, dienogest 2 mg daily, and resveratrol 100 mg + dienogest 2 mg daily. During treatment, the average size of the junctional zone decreased, especially after combined treatment (p = 0.03). Conclusion: The significance of the assessment of the junctional zone in the diagnosis of adenomyosis is currently small, due to the peculiarities of its visualization in some patients, however, the assessment of the thickness and uniformity of the junctional zone can be successfully used in the complex diagnosis of the disease. Furthermore, dynamic assessment of these parameters is a useful tool for monitoring treatment effectiveness, particularly during maintenance therapy.
Disorders of spermatogenesis represent a significant yet insufficiently studied factor that influences the outcomes of assisted reproductive technology (ART) programs and the incidence of early reproductive loss. The aim of this review was to systematize current evidence on the relationship between routine and advanced parameters used for the assessment of spermatogenesis and embryo quality, ART effectiveness, and the risk of implantation failure. The results of large retrospective and prospective studies, as well as systematic reviews and meta-analyses, addressing the role of sperm concentration, motility, morphology, and sperm DNA fragmentation in determining embryological and clinical outcomes of ART have been analyzed. It has been shown that conventional semen parameters have limited prognostic value, whereas sperm DNA fragmentation is associated with reduced clinical pregnancy rates and an increased risk of miscarriage. Special attention is given to modern methods for assessing sperm DNA integrity and their diagnostic capabilities. The review also discusses the impact of oxidative stress and the role of antioxidant therapy in the context of male preconception preparation prior to ART programs. The review highlights the importance of a comprehensive evaluation of male reproductive function and a personalized approach to patient management in order to improve ART outcomes and reduce the risk of early reproductive loss.
One in ten women worldwide (285–400 million people) lives with a genitourinary malformation. Urogenital anomalies often remain undetected, despite the advanced 21st century medical technologies. As a result, many of these women undergo infertility treatment without being aware of the true underlying cause of their condition. Using two clinical cases from the authors’ own experience in the management of reproductive-age patients with Müllerian duct anomalies, this article provides a detailed analysis of why timely detection of genitourinary malformations is critically important. In the first clinical case, the patient had an untimely diagnosis of Herlyn–Werner–Wunderlich syndrome, which likely resulted in a series of unnecessary surgical interventions and subsequent complications. In the second clinical case, the patient was diagnosed with a bicornuate uterus, incomplete vaginal duplication, and partial aplasia of the left vagina, which may have been the cause of many years of infertility. In both cases, the patients underwent surgical treatment aimed at creating an artificial perforation of the previously obstructed vagina, thereby enabling free menstrual drainage. Surgical management reduced the risk of complications associated with the development of hematocolpos, hematometra, and hematocervix, and significantly improved the patients’ quality of life. Expert and timely diagnosis, rational surgical management, and a high level of professional expertise enabled these patients to achieve their reproductive goals.
The female reproductive tract microbiota plays a key role in maintaining women’s health, including the reproductive function. Contemporary research refutes the notion of sterility in the upper reproductive tract and proves the existence of unique microbial communities in the vagina, cervical canal, endometrium, fallopian tubes, and ovaries. An imbalance in this ecosystem — dysbiosis — is characterized by a decrease in lactobacilli (especially Lactobacillus crispatus) and an increase in opportunistic pathogens (Gardnerella, Prevotella, Atopobium). This condition is associated with a wide range of pathologies, such as chronic endometritis, infertility, pregnancy loss, pelvic inflammatory disease, and endometriosis, as well as the persistence of human papillomavirus and the progression of cervical neoplasia. Dysbiosis triggers a local inflammatory response, creating unfavorable conditions for embryo implantation and pregnancy progression. The diagnosis of microbiota disorders is currently undergoing significant changes. Traditional methods (microscopy, culture) are increasingly being replaced by high-precision molecular genetic technologies, such as 16S ribosomal RNA gene sequencing and metagenomic analysis, which allow for a detailed characterization of the taxonomic and functional potential of the microbiota. Modern approaches to correcting dysbiosis include not only etiotropic antibiotic therapy but also strategies for restoring a normal microbial balance using probiotics, synbiotics, phage therapy, postbiotics, and promising methods such as vaginal microbiota transplantation. Thus, comprehensive assessment and targeted modulation of the female reproductive tract microbiota open new avenues for personalized and targeted therapy of gynecological diseases and improving reproductive outcomes.
BACKGROUND: An increasing number of women of early reproductive age have uterine fibroids but are postponing their fertility and are interested in using highly effective contraception, including combined oral contraceptives. Clinical manifestations of uterine fibroids can negatively affect patients’ quality of life. However, a single study has published the results of a positive impact of combined oral contraceptive use on the quality of life in women with uterine fibroids. The specific factors that contribute most significantly to the negative impact on the quality of life in this cohort of women and their relative importance have not been studied. AIM: The aim of this study was to identify factors that influence the quality of life of women with types 3, 4, 5, and 6 uterine fibroids according to the Federation International of Gynaecology and Obstetrics (FIGO) classification without indications for surgical treatment, and to generate a mathematical model to assess the risk of negative quality of life declines in this cohort of patients. METHODS: This study included patients with FIGO types 3, 4, 5, and 6 uterine fibroids without indications for surgical treatment. Some used multiphasic (ethinyl estradiol + desogestrel) or monophasic (ethinyl estradiol + various progestogens) combined oral contraceptives. Various clinical, anamnestic, and psychosocial characteristics of the patients were initially recorded. Quality of life was assessed at baseline and after 12 months, using the SF-36 questionnaire, and the size of the fibroid nodes was evaluated by ultrasound examination. We used standard methods for comparative statistical analysis, the classification tree method, and logistic regression tools. RESULTS: Of the 118 patients, 54 used combined oral contraceptives, while 64 did not. Based on the analysis of 48 different clinical, instrumental, laboratory and anamnestic data, four parameters were found to be significant for the quality of life of such patients: greater age (x1), longer diameter of the largest/single fibroid (mm) (x2), presence of symptoms of uterine fibroids (x3) reduces the quality of life and increases the risk of its negative declines, and use of multiphasic/monophasic combined oral contraceptives (x4) is the only factor that increases the quality of life and reduces the risk of its negative declines. Using logistic regression, a model was created to assess the risk of negative quality of life declines in the studied cohort of patients: ψ=0.099x1+0.111x2+2.369x3−6.577x4−4.879. CONCLUSION: The data obtained allow concluding that the use of both multiphasic and monophasic low-dose combined oral contraceptives is an equally highly effective technology that helps reduce the risk of negative quality of life declines in patients with FIGO types 3, 4, 5, and 6 uterine fibroids without indications for surgical treatment.
Background: Over the past decade, the incidence of non-alcoholic fatty liver disease (NAFLD) in pregnant women has increased significantly, reaching approximately 10% of all cases; the disease being associated with an increased risk of hypertension, postpartum bleeding, and preterm birth. Pregnant women with NAFLD should be considered a high-risk group due to potential adverse perinatal and obstetric outcomes and potential impact on offspring health. Аim: The aim of this study was to identify NAFLD prevalence and risk factors in patients entering pregnancy. Мethods: This retrospective observational case-control study included data from the medical histories and outpatient records of women who were pregnant between February 2019 and December 2022 (n = 2023). The main group consisted of pregnant women with NAFLD in the first trimester (n = 104), while the remaining pregnant women without a diagnosis of liver or biliary disease were considered the control group. The patients’ blood biochemical parameters were monitored. Additionally, the following were evaluated: the age of pregnant women, the number of pregnancies, the number of fetuses, body weight, body mass index (BMI), bad habits, social status, and the number of previous births. All statistical analyses were performed using MedCalc (version 23.4), Statistica (version 13), and Excel (version 19) software with XRealStats add-ins (version 4.4.1). Statistical significance was determined as a two-sided p value 0.05. Disease prevalence was calculated using the generally accepted formula in Excel (version 19), and the significance of within-group differences was determined between the numbers of patients with or without NAFLD. Results: NAFLD prevalence in pregnant women in the first trimester was 5.14% (p 0.001). The following risk factors were proven for NAFLD: BMI levels (AUC area = 0.933, maximum value of the Youden index J = 0.7806, associated criterion 27.1); total cholesterol levels (AUC area = 0.945, p 0.001, maximum value of the Youden index J = 0.7655, associated criterion 6.0); smoking (maximum value of the Youden index J = 0.7806, associated criterion 27.1); the number of pregnancies in the anamnesis (β = 0.3257), odds ratio ≈ 1.38. Conclusion: At the initial visit for pregnancy follow-up, NAFLD incidence was more than 5% in our study. The identified risk factors for NAFLD were elevated BMI and total cholesterol levels, smoking, and history of multiple pregnancies. Such patients should undergo additional examination, including liver ultrasound, lipid profile, and liver function tests, to ensure timely detection and treatment of this condition and reduce the incidence of obstetric complications.
BACKGROUND: Pelvic floor pathology is a leading cause of gynecological disease, affecting many women of all ages and negatively impacting their quality of life. Despite numerous scientific publications and constantly evolving approaches to diagnosis and treatment, many questions remain open, and the need to improve early diagnosis and prevention methods continues to be an urgent task. The need to implement innovative analytical tools based on mathematical predictive models underscores the critical importance of in-depth study of the risk factors that influence the development of pelvic floor dysfunction. AIM: Based on the analysis of the anatomical and functional characteristics of the female pelvic floor, the aim of this study was to develop a prognostic model for assessing the risk of developing pelvic dysfunctions in women. METHODS: A single-center case-control study was conducted. In Group 1, patients reported the onset of pelvic floor dysfunction symptoms within the past 12 months; in Group 2, there were no complaints associated with pelvic dysfunction. Inclusion criteria were age above 18 years or older, Caucasian ethnicity, and signed informed consent. Pregnant women, recent postpartum women (less than 24 months), and those with acute gynecological conditions or genital malformations were excluded. Anatomical and functional characteristics were evaluated using the Pelvic Organ Prolapse Quantification System (POP-Q) and PERFECT systems, alongside pelvic floor ultrasound measurements. Binary logistic regression was utilized to develop a predictive model, validated by ROC curve analysis. RESULTS: The study involved 218 women: 115 patients in Group 1 and 103 patients in Group 2. The most significant predictors for pelvic floor dysfunction included pelvic floor muscle contraction strength (p = 0.012), difference in urethral inclination α-angle at rest and during the Valsalva maneuver (p = 0.016), height of the perineal tendon center (p = 0.017), number of pelvic muscle contraction repetitions when assessed using the PERFECT system (p = 0.019), thickness of musculus puborectalis (p = 0.030), thickness of musculus bulbospongiosus (p = 0.030), pelvic floor muscle endurance (p = 0.039), and asymmetry index of musculi bulbospongiosus (p = 0.046). The model demonstrated high predictive accuracy (AUC 0.870; sensitivity 78.3%, specificity 82.5%). CONCLUSION: The created model for assessing the risk of developing pelvic floor dysfunction has high prognostic characteristics. A key advantage of the created model is its universality in relation to the age of patients, which allows assessing the risk of pelvic dysfunction in women at different age periods. Using the created model for assessing the probability of developing pelvic dysfunction in women will enable timely correction of any identified pathology.
