Among the rare morphological variants of ectopic pregnancy, interstitial pregnancy occupies a special place. The diagnostic complexity of this variant is determined by the anatomical and topographic features of the implantation site and the limited information content of ultrasound methods in early gestation. This paper presents a clinical observation of interstitial pregnancy in a 30-year-old female patient with a surgical history of left fallopian tube excision due to pyosalpinx. The patient underwent a comprehensive examination, including a clinical examination, laboratory tests, transvaginal and transabdominal ultrasound scanning, and histological verification of the surgical specimen. Analysis of the presented clinical observation confirmed the ectopic implantation variant—interstitial location of the fertilized egg within the fallopian tube stump extending to the left uterine horn. Laparotomy with excision of the implantation site prevented the development of hemorrhagic complications and preserved the patient’s reproductive potential. This observation highlights the importance of timely surgical intervention as the most effective method for preventing complications and maintaining reproductive health.
Management of patients with vulvar lichen sclerosis (VLS) in most cases involves conservative therapy. However, inadequate or no conservative therapy can lead to conditions requiring surgical intervention (suspected malignancy, functional impairment). Surgical treatment for VLS is associated with the risk of complications and the formation of wound defects, leading to cicatricial changes and a deterioration in quality of life. Objective. To analyze reconstructive surgeries performed in patients with various types of VLS requiring surgical treatment. Materials and methods. A single-center, consecutive series of observations included 17 patients with complications of VLS requiring surgical treatment (vulvar resection or vulvectomy with vulvar reconstruction). Postoperatively, sodium deoxyribonucleate was administered, and recommendations for supportive care were provided. Postoperative follow-up ranged from 6 months to 6 years. Results. The appearance of the external genitalia in patients with various types of VLS before and after surgical treatment and comprehensive anti-relapse therapy is described and presented in photographs. Surgical treatment of patients with VLS is indicated when conservative therapy is ineffective, differentiated vulvar intraepithelial neoplasia, cancer, functional impairment, and complications of previous interventions. In the case of the atrophic variant, surgery is required less frequently, primarily for stenosis and dysuria, and organ-preserving treatment is often possible. Sclerosing and scleroatrophic lichen sclerosis more often require vulvectomy followed by vulvectomy reconstruction. Conclusion. Surgical treatment is not a generally accepted treatment option for patients with lichen sclerosis. Indications for surgical intervention for lichen sclerosis include failure of conservative therapy, differentiated vulvar intraepithelial neoplasia, vulvar cancer, functional impairment, and complications from previous surgeries or photodynamic therapy. Patients with the atrophic variant of lichen sclerosis require surgery less frequently, while patients with the sclerosing and scleroatrophic variants typically require a more radical approach, including vulvectomy followed by vulvectomy reconstruction.
Objective. To determine the incidence of menstrual dysfunction depending on the «COVID status» and the level of immunization in female students of various higher educational institutions in Russia and neighboring countries during the COVID-19 pandemic, as well as to identify possible predictors of these disorders. Material and methods. An international, cross-sectional, multicenter study was conducted among female students of universities in Russia, Georgia, and Uzbekistan. Data were obtained using an online survey. The study included 1.671 students. Respondents were divided into 3 groups depending on their «COVID status» and immunization level: Group 1 — students who had had symptomatic clinically manifested novel coronavirus infection, confirmed by PCR testing, and unvaccinated (n=169); Group 2 — primarily vaccinated (n=1.310). Group 3 (control) included female students without a history of novel coronavirus infection and were not vaccinated at the time of the survey (n=192). To study the predictors of menstrual dysfunction (MD) during the novel coronavirus pandemic, two additional comparison groups were formed: the first group included respondents with changes in menstrual function (MF) (n=635), and the second group included respondents with no changes in MF (n=1036). Results. The incidence of MD was 38%. The most common predictor was an extended menstrual cycle, noted in 25% of those with novel coronavirus infection and in 22.4% of the control group. The second most common predictor (20.2%) was increased menstrual pain, which was more pronounced in the subgroup of those with novel coronavirus infection (20.2%). In third place is an increase in premenstrual symptoms (PMS), without significant differences in the survey groups. Fourth place (11.3%) is an increase in the intensity of menstrual blood loss, which was significantly more common after COVID-19. The most significant predictors of MFD during the pandemic were identified as follows: a history of COVID-19 with symptoms confirmed by PCR testing (odds ratio — OR — 1.7; 95% confidence interval — CI — 1.2-2.3), moderate to severe depression (OR — 1.6; 95% CI — 1.2–2.1), a history of diseases associated with MFD (OR — 1.7; 95% CI — 1.2–2.5), MFD before the pandemic (OR — 1.3; 95% CI — 1.1–1.5). Primary vaccination was a protective factor (OR 0.8; 95% CI 0.6–0.9). Conclusion. During the COVID-19 pandemic, the proportion of female students with MFD was 38.0%. One in four female students who had COVID-19 and one in five female students in the control group reported an extended menstrual cycle (MC). Increased menstrual pain and intensity, as well as premenstrual syndrom, were observed in all study groups. Meanwhile, more painful and heavy menstrual periods were observed in female students who had COVID-19. The most prognostically significant predictors of MFD were a previous novel coronavirus infection with symptoms confirmed by PCR testing, moderate to severe depression, and a history of illnesses associated with MFD.
Postpartum endometritis is a pressing issue in modern obstetrics. Risk factors for the development of postpartum endometritis include uterine scarring, premature rupture of membranes, surgical correction of cervical insufficiency, and chorioamnionitis. Rational antibacterial therapy is recognized as the primary treatment for women with postpartum endometritis. However, if the condition becomes generalized, it can lead to indications for hysterectomy and the development of sepsis, which is a leading cause of maternal mortality. This case report concerns a multiparous patient with a uterine scar whose second pregnancy resulted in an emergency abdominal delivery at 26 weeks of gestation with an unfavorable perinatal outcome, as well as the development of severe endometritis one month after delivery. Organ-preserving surgical treatment in the gynecology department of the V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology and rational antibacterial therapy enabled the patient to preserve reproductive function and prolong her subsequent pregnancy until a favorable perinatal outcome.
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathic disorder characterized by severe thrombocytopenia, microangiopathic hemolysis, and multiorgan dysfunction. In obstetric practice, TTP often mimics severe forms of preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, thrombocytopenia), leading to diagnostic errors and delays in treatment. This article presents the case of a young primiparous patient who, at 38 weeks of gestation, developed clinical features consistent with HELLP syndrome and was diagnosed with ADAMTS13 deficiency. This allowed for the confirmation of the diagnosis of TTP and prompt modification of treatment.
This review of published works summarizes current data on the prevalence, etiology, pathogenesis, diagnosis, and treatment of premature ovarian failure (POF). Projective. To present a systematic analysis of published works on the problem of premature ovarian failure, diagnostic capabilities, and optimal treatment methods for this pathology. The analysis includes data from international and domestic studies published in the Scopus, Elibrary, Pubmed, Google Scholar, Web of Science, Paperity, DOAJ, re-pository.tma.uz, archivog.com, and Media Sphere databases up to 2024. The article primarily presents data from scientific papers published over the past 10 years. The clinical presentation is characterized by oligo- or amenorrhea and genitourinary menopausal syndrome. Patients with POF require a specific approach and treatment depending on their reproductive plans. The primary treatment for patients with POF is hormone replacement therapy. Early detection of latent and clinically manifest forms of POF using pelvic ultrasound, assessment of hormonal status, and clinical symptoms helps practitioners develop a management algorithm for patients with this condition to prevent age-related diseases.
This article is devoted to a pressing issue in modern obstetrics: the use of ultrasound navigation in labor to reduce the incidence of cesarean sections and optimize delivery strategies. The authors analyze the experience of international and domestic colleagues, paying particular attention to key ultrasound parameters such as the angle of progression (AoP), the occiput-spine angle (OSA), the head-perineum distance (HPD), and others. They emphasize that the use of traditional vaginal examination alone during labor is prone to errors, while ultrasound monitoring allows for an objective assessment of the fetal head position, predicting the success of vaginal delivery, and minimizing surgical interventions. The article presents research data demonstrating the prognostic value of ultrasound parameters: for example, an AoP ≥145° is associated with successful vaginal delivery (98%), and an HPD >55 mm correlates with unsuccessful attempts at vacuum extraction. In addition, new parameters such as the buttock flexion angle in breech presentation and the posterior cervical angle are considered for predicting successful labor induction. Particular attention is paid to the use of ultrasound examination during labor in women with a uterine scar, in whom a lower uterine segment thickness of less than 2.3 mm may indicate the risk of uterine rupture.
The article analyzes literature data and presents its own observation of fatal anaphylactic shock in a pregnant woman caused by the prophylactic use of ceftriaxone in the perioperative period during caesarean section.
This article presents a review of scientific research by Russian and international authors examining the tactics of choosing a sterilization method during caesarean section, the characteristics of the postoperative period, as well as possible complications from both a surgical perspective and the long-term consequences of the sterilization technique. The objective of this study was to substantiate the absence of a negative impact of salpingectomy during cesarean section as a method of surgical sterilization and the reduction in the risk of ovarian cancer after salpingectomy. The question of the surgical method of sterilization during cesarean section remains open. Some authors advocate suturing/ligation/electrocoagulation of the fallopian tubes, while others present compelling arguments in favor of salpingectomy. A detailed analysis of Russian and primarily international studies on surgical sterilization, primarily during cesarean section, was conducted, as well as statistical data on the occurrence and prevalence of ovarian malignancies. The following databases were used in this article: PubMed, eLibrary, and Medline.
The article presents a clinical observation of a patient with early perimenopause, which developed against the background of somatic pathology and chronic stress. Based on the analysis of complaints, medical history, and clinical and laboratory examination data in the dynamics according to the stages of reproductive aging (–2 and –1) on the STRAW+10 scale, an individual treatment regimen was selected taking into account the patient’s wishes, nutritional priming* (focused nutritional support aimed at improving the regulation of the hormonal system) and therapy were performed. peptide bioregulators (biologically active substances based on peptides) with a positive result.
This paper presents a clinical observation of the course of pregnancy and childbirth a patient with kidney transplant.
Objective. Search for an optimal ultrasound examination technique that allows for increased accuracy in assessing the angle of urethral inclination, taking into account fixed anatomical landmarks. Material and methods. The study included 30 women of reproductive age without signs of stress urinary incontinence and pelvic organ prolapse. The angle of urethral inclination was assessed using transperineal ultrasound in three body positions: lying on the back on a horizontal plane, in the lithotomy position, and lying on the back with a cushion under the lower back. Two methods of measuring urethral rotation were compared: the first was an assessment relative to the vertical axis passing through the neck of the bladder; the second was an assessment relative to the longitudinal axis of the pubic symphysis. Results. The first technique demonstrated high variability when changing the patient’s body position — in the supine position on the median plane, the urethral inclination angle was 14º [8; 17]º, in the lithotomy position — 20º [16; 25]º, in the supine position with lumbar support on a bolster — 10º [7; 12]º. When assessing the dynamic change in this angle depending on the body position, statistically significant differences were noted (Friedman ANOVA method: χ2=37.83; p=0.001). At the same time, when using the second technique, more stable results were determined, less dependent on the pelvic inclination angle. In the supine position on the plane, the urethral inclination angle was 70º [57; 79]º, in the lithotomy position — 72º [67; 86]º, in the supine position with lumbar support on a bolster — 69º [58; 80]º. At the same time, urethral mobility depending on the patient’s body position when using the second technique also had statistically significant deviations (χ2=18.79; p=0.02), but these fluctuations were less pronounced. Thus, when changing the body position from the supine position on a plane to the lithotomy position when using the first technique, the angle of inclination of the urethra increased by 42.8% (1.4 times), while when using the second technique, the fluctuations were minimal — by 2.8%. Conclusion. Measuring the angle of urethral inclination relative to the longitudinal axis of the pubic symphysis minimizes the influence of the patient’s body position and anatomical features on the results obtained. This transperineal ultrasound technique helps to increase the accuracy of detecting stress urinary incontinence and can become a standard for diagnosing urethral mobility in women.
Objective. Analysis of pregnancy course and birth outcomes in women with transplanted organs. Material and methods. This retrospective single-center study included an examination of the course of 30 pregnancies in 28 women: 25 pregnancies after kidney transplantation (KT) in 23 patients, including two pregnancies in two patients after combined KT and pancreas transplantation (PT), and five pregnancies in five patients with (non-renal) organ transplants. Each pregnancy was considered a separate clinical observation. Among the pregnancies after non-renal transplants, two occurred after heart transplantation (HT), one after heart-lung transplantation (HLT), one after lung transplantation (LT), one after liver transplantation (LiT). Results. We present an analysis of the pregnancy course and birth outcomes in patients with solid organ transplants observed at the V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology. A high incidence of gestational diabetes mellitus (GDM) was noted in women with KT — 34.8%. In two patients after non-renal transplantation, pregnancy was complicated by the development of GDM. Almost every fourth pregnancy was complicated by the development of preeclampsia, which significantly exceeds the population level. The incidence of baseline and gestational arterial hypertension reached 47.8 and 43.5%, respectively. According to our data, the incidence of preterm birth in pregnant women with KT was 56.3%, and in two cases, preterm births occurred in patients with HT and HLT. Predictors of preterm birth in this patient category are presented. Anemia was observed in 73.8% of pregnant women with KT, and in all pregnant women with HT and HLT. Conclusion. Successful pregnancy and the birth of a healthy child are possible in women with organ transplants with careful planning and monitoring before conception, during pregnancy, and in the early postpartum period.
The aim of the study was to analyze the catamnesis of patients who underwent surgical treatment of placenta accreta in specialized perinatal centers in the Russian Federation. Materials and methods. A retrospective multicenter study, analysis of clinical and anamnestic data, gynecological and obstetric catamnesis of 2.652 patients who underwent surgical treatment for placenta accreta in 2014—2024 in 31 regions of the Russian Federation, as well as V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation, V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia and hospitals of the Mother and Child Group of Companies. Results. Among the total cohort of 2652 patients, 229 (8.6%) patients underwent hysterectomy during surgical treatment of placenta accreta, 2423 (91.4%) patients underwent organ-preserving surgery, of which 609 (23%) underwent surgical sterilization. Hysterectomy compared with metroplasty was accompanied by a significantly greater blood loss of 2403 (1974—2850) versus 1693 (1105—23 75) ml (p<0.001), a higher incidence of intraoperative complications such as massive blood loss of more than 2500 ml (30.56% (n=70) versus 6.93%, (n=168), (p<0.001) and bladder resection (31.88% (n=73) vs. 2.23% (n=54), (p<0.001). In 2018 (83.28%) patients with organ-preserving surgery, the regular menstrual cycle was restored 4 (1—18) months after the operation. Menstrual cycle disorders and/or a symptomatic niche of the postoperative scar were noted in 55 (2.27%) cases. Clinical and laboratory manifestations of premature menopause were not observed in any case. Among 229 patients who underwent hysterectomy, 17 (7.42%) cases showed symptoms of premature menopause. The frequency of urinary problems did not differ significantly between the groups, amounting to 116 (4.78%) versus 15 (6.55%) cases (p=0.242), in metroplasty and hysterectomy, respectively. According to the PISQ questionnaire, sexual satisfaction was statistically higher in the group with organ-preserving surgery — 5 points, compared with organ-bearing surgery — 3 points (p=0.031). When analyzing the quality of life and health based on the Short Form 6 Dimensions SF-6D questionnaire in women with metroplasty, the median score was significantly higher than in patients with a removed uterus: 4 (3—5) versus 3 (1—4) of the maximum 5, respectively (p=0.031). Of the 1.814 patients with preserved reproductive function, subsequent pregnancies were observed in 7.88% (n=143), 88.11% (n=126) of which ended in delivery. The frequency of timely delivery was significantly higher than that of preterm delivery: 83.33% (n=105) cases versus 16.67% (n=21) (p<0.001). Among all deliveries, the median volume of intraoperative blood loss was 880 ml. Placenta accreta was diagnosed in 7.1% (n=9) of the cases, in one of which (0.79%, 1/126) it was complicated by massive blood loss, which caused a hysterectomy. Postpartum bleeding occurred in 3 (2.38%) patients. Neonatal outcomes did not differ from the population data. An analysis of blood flow reduction methods in the previous surgical treatment of placenta accreta demonstrated a significant correlation between the use of complex compression hemostasis with the possibility of organ-preserving surgery and the uncomplicated course of subsequent pregnancy. Conclusion. The results of the second stage of a multicenter nationwide study demonstrated that organ-preserving surgery for placenta accreta is associated with fewer intra– and postoperative complications, improved quality of life in patients and the possibility of further realization of their reproductive function.
Objective. To evaluate and to compare oncological and reproductive results of hormonal therapy in young women with atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC) according to experience of N.N. Blokhin NMRCO. Methods. Retrospective trial of 84 reproductive age women with AEH and EC (endometrioid grade 1 adenocarcinoma) without myometrial invasion fertility-sparing treated in oncogynecological department of N.N. Blokhin NMRCO from may 2020 to october 2025. EC patients were treated with combination of levonorgestrel intrauterine device (IUD) and gonadotropin-releasing hormone agonist (GnRH). AEH patients were treated with levonorgestrel IUD only. Results. Total of 84 patient were analyzed, AEH (n=26) and EC (n=58). Complete response rate was 100% in AEH and 94.8% in EC. There were no recurrences in AEH group with median follow-up 27.3 (5—47) months. The recurrence rate in EC group was 7.4% with median follow-up 24.5 (1—58) months. The overall conception rate was 21.4%, among them 55.6% with assistant reproductive technologies use. Of total 84 patients 12 (14.3%) delivered successfully. Conclusion. Hormonotherapy of AEH and EC is effective and safe method of fertility-sparing treatment with high probability of conception and delivery.
Fetal growth restriction and preeclampsia, the underlying pathogenesis of which is placental insufficiency, are among the leading causes of perinatal and maternal morbidity and mortality worldwide. Objective. To study the association between vaginal microbiome and placental protein levels in the first trimester of pregnancy with the risk of developing of placental insufficiency. Material and methods. The study included 283 patients without history of obstetrical, gynecologic, or medical conditions. Each patient had their placental protein levels assessed-human chorionic gonadotropin (hCG) and placental-associated plasma protein A (PAPP-A) — based on the initial screening, and their vaginal microbiota in the first trimester of pregnancy was analyzed using polymerase chain reaction. Depending on whether placental insufficiency subsequently developed, all patients were divided into two groups: Group 1 — 203 patients without placental insufficiency; Group 2 — 80 patients whose pregnancy was complicated by the development of placental insufficiency. Results. Patients of Group 2 had statistically significant lower concentrations of placental proteins — hCG and PAPP-A — as well as higher levels of Gardnerella vaginalis, Prevotella bivia, Porphyromonas spp., and Eubacterium spp. — were detected in the first trimester of pregnancy compared to those in Group 1. According to the study results, with a PAPP-A MoM level ≤0.486 based on the first prenatal screening data and the number of Sneathia spp., Leptotrichia spp., and Fusobacterium spp. bacteria, A vaginal microbiota with ≤107.3 DNA copies is associated with a high risk of developing placental insufficiency. Conclusion. Patients with reduced levels of placental proteins based on the initial prenatal screening and higher numbers of opportunistic microorganisms in the first trimester of pregnancy have a higher risk of developing placental insufficiency in late gestation. Timely correction of the vaginal microbiota during the preconception period and early pregnancy may be an important way to prevent placental insufficiency.
Modern methods for diagnosing and predicting infectious inflammations after childbirth demonstrate that infections can manifest in non-obvious and atypical forms. These manifestations often do not correspond to the expected severity of the inflammatory response, which may be associated with the widespread use of antibiotics, as well as with individual health factors of the woman, including her social status, presence of chronic diseases, threats of miscarriage during pregnancy, and complications arising during pregnancy and childbirth. Algorithmic approaches to prediction can effectively assess the risks of specific diseases and their consequences, which significantly improves the possibilities for disease prevention and control. The creation of personalized treatment strategies based on clinical data and analyses contributes not only to more targeted treatment but also reduces the cost of medical services. Infectious and inflammatory diseases (IIDs) in the postpartum period consistently rank from second to fourth among the leading causes of maternal mortality. Various studies show that their prevalence ranges from 13.3% to 54.3%. These diseases, such as endometritis — the most common form of postpartum IID — reduce women’s reproductive potential and contribute to the development of chronic inflammatory processes in the female genital organs. This gives them particular medical and social importance in the context of the demographic crisis.
Objective. To evaluate the efficacy and safety of different methods of labor analgesia in women with epilepsy. Materials and Methods. A prospective observational study was conducted involving 313 women with epilepsy who delivered vaginally between 2017 and 2024. Patients were divided into groups according to disease activity (active epilepsy, medication-induced remission, and drug-free remission lasting more than 5 years). For pain relief during vaginal delivery (n=313), pharmacological analgesia (PA), epidural analgesia (EA), and their combination (EA+PA) were used. Analgesic efficacy was assessed using changes in pain intensity on the Visual Analog Scale (VAS) and levels of biochemical stress markers (salivary α-amylase and substance P). Results. The combined method (EA+PA) demonstrated the highest efficacy: 60—90 minutes after initiation of analgesia, VAS pain scores decreased by 47—54%, while stress marker levels decreased by 24—60%. In patients with active epilepsy and high anxiety levels, this method provided the most stable analgesic effect. When epidural analgesia was used alone, pain intensity increased by the end of labor and returned to levels comparable to baseline values. Conclusion. Combined labor analgesia (EA+PA) is the most effective method for spontaneous vaginal delivery in women with epilepsy, particularly in nulliparous women with active disease. Management of these patients requires a multidisciplinary approach and individualized anesthetic care, taking into account their psycho-emotional status.
This analytical review covered 10 years of published scientific articles, from January 1, 2014, to February 28, 2025, devoted to the impact of gestational diabetes mellitus (GDM) on maternal and child health. It was shown that carbohydrate metabolism disorders present during pregnancy can progress and lead to the development of type 2 diabetes as early as 2—3 years after birth. Children born from mothers with gestational diabetes are also at risk of developing metabolic and neurosensory disorders, the severity of which depends on the subtype of gestational diabetes. The need for preventive and rehabilitative measures in the postpartum period is obvious, but is complicated by the unique living conditions of nursing mothers. The development of personalized lifestyle modification programs may be a promising approach to improving the health of mothers with gestational diabetes and their children and preventing the adverse consequences of gestational diabetes.
Substance P (SP) was found in the uterus of women. It is a neuropeptide that exerts a vasodilatory effect on uterine vessels and stimulates the contractility of myometrial smooth muscle cells. This may have pathogenetic significance in the development of pregnancy complications and determine the volume of potential blood loss. Objective. To study the effect of immunohistochemical expression of SP in the uterus on the occurrence of gestational complications and blood loss during repeat cesarean section. Material and methods. A comprehensive examination of 22 women following repeat cesarean section (CS) at 37—41 weeks of gestation was performed at the obstetric hospital of the Kursk Regional State Healthcare Institution, Emergency Hospital, Kursk. In addition to medical history, complete blood counts were reviewed, and objective obstetric, ultrasound, and Doppler ultrasound examinations were analyzed, as well as the results of immunohistochemical staining of uterine tissue biopsies with polyclonal antibodies recognizing β-receptor agonists. Results. Higher β-receptor agonist immunohistochemical expression was associated with lower blood color index values and slightly greater blood loss during CS, confirming the vasodilatory effect of this neuropeptide and indicating its significant role in uterine blood loss during spontaneous labor and CS. Furthermore, differences in red blood cell concentrations were demonstrated in women depending on β-receptor agonist expression levels. In particular, elevated uterine SP levels were associated with higher red blood cell (RBC) concentrations. It is suggested that hypoxia, which accompanies chronic inflammatory processes in the uterus, stimulates SP expression and potentiates its effect on erythropoiesis. Conclusion. High uterine SP expression in women with repeat cesarean sections tends to be associated with greater blood loss during cesarean section and may be a consequence of inflammatory uterine diseases.
