Aim. To clarify and summarize current data on the relationship between morphological features of gravid transformation of the endometrium and early reproductive losses in women with obesity. Key points. The growing prevalence of obesity worldwide is of serious concern not only due to numerous metabolic complications associated with excess visceral adipose tissue, but also due to reproductive dysfunction in women. Obesity is considered a key factor that increases several times the likelihood of pregnancy complications such as spontaneous abortion, non-viable pregnancy, stillbirth, gestational diabetes mellitus, and preeclampsia. The development of adverse events in the context of maternal obesity may be based on the interaction of biological processes associated with pregnancy and chronic inflammation caused by obesity. However, the causal relationship between BMI and spontaneous abortion is not fully understood, possibly due to the multifactorial effects of excess body weight on pregnancy progression. In addition, BMI as an isolated variable may not reflect other important health risk factors such as nutrition, physical activity, and insulin resistance. Conclusion. Female obesity is associated with worse natural and assisted conception outcomes, including an increased risk of spontaneous abortion. Low-grade inflammation affecting arterial remodeling, placentation, and uterine immune cell composition and activity in maternal obesity contributes to a high incidence of pregnancy complications. The development of a unified morphological panel that takes into account the main indicators of endometrial transformation processes with an assessment of its receptor profile and diagnostically significant immunological factors will allow verification of endometrial pathology at the molecular level and justification of pathogenetic therapy in the risk group of early reproductive losses in women with obesity. Keywords: gravid endometrium, obesity, reproductive function, reproductive losses, miscarriage.

Induced abortion remains controversial due to traditional, moral, political, and religious reasons. Although the common opinion about the illegality of abortion is indicated in medical conditions, its regulation varies widely according to the country. Abortion is available to women on request in many countries, while in others, there is restriction or prohibition altogether. In the contest when some countries end the nationwide right to abortion, the Republic of Benin in 2020 broadened the social grounds, allowing abortion up to 12 weeks of gestational age. This paper aims to overview abortion legislation in selected countries and to compare them to the reform in the Republic of Benin, which became one of the several African countries broadly permitting abortion within 12 weeks of amenorrhea.

The maternal mortality ratio in the Republic of Benin in 2015 was still high – 405 per 100,000 live births. The delay in consultation and timely treatment, unavailability of medical facilities and lack of skilled care are the principal factors contributing to maternal deaths in Benin. Consequently, the rate of such preventable causes of maternal deaths like obstetric haemorrhage (38.40 percent and pre-eclampsia/eclampsia (14.30 percent) remains high in the country, and even HIV continued being one of the indirect causes of maternal deaths in 2017 – one percent. High rate of complications associated with pregnancy and birth in adolescent girls is another cause of maternal deaths in the Republic of Benin. Despite the efforts of the Government aimed at improving health care, it is unlikely that we will achieve the United Nations Sustainable Development Goals 3.1. – the reduction of maternal mortality ratio to less than 70 per 100,000 live births by 2030.

Background: Pelvic organ prolapse (POP) is the most frequent disease component in the structure of gynecological pathology (from 28 to 38.9%) and its incidence is increasing. Most of the research studies were initiated to develop various kinds of operative treatment for common prolapse cases (POP-Q III−IV); however, a large number of surgical interventions associated with a high percentage of complications and a high rate of relapses confirm the difficulty for problem-solving. In this regard, there is a need to expand ideas about the pathogenesis of the disease and develop approaches to the prediction of recurrence surgical treatment, choosing the correct and timely treatment strategy. Currently, great importance is given to the study of genetic control of connective tissue metabolism. The evidence demonstrated that polymorphism of NAT2 gene results in genetically determined disorders of connective tissue catabolism which increases the possibility of disease development approximately in 2 times. Point mutations in NAT2 lead to the so-called slow-acetylation which determines the predominance of the decay rate of collagen over its synthesis.Aim: Analyze the significance of NAT2 polymorphism as a predictor for failure of surgical treatment of pelvic organ prolapse.Materials and methods: The prospective cohort clinical trial enrolled 140 women of the reproductive age (from 28 to 42 y.o.) with symptomatic prolapse (POP-Q Stage II−III) who were examined and received treatment in the period from 2008 to 2014. All patients underwent surgical treatment of POP. The treatment included colpoperineorrhaphy with levatorplasty. In 12.9% of patients who had stress urinary incontinence — in combination with a loop urethropexies transobturatory access (Transobturator Vaginal Tape, TVT-O). Long-term results of treatment effectiveness were assessed in 3−5 years. Results: The findings revealed that the incidence rate of point mutations of NAT2 gene was 2-fold higher in patients with POP included in the ineffective treatment group (61.8%) if compared to the rate registered in the effective treatment group (30.6%).Conclusions: The obtained data indicate that the presence of point mutations in NAT2 gene is a poor prognostic factor for general types of genital prolapse and a predictor for failure of surgical treatment.

Dystrophic processes of a vulva were and remain a problem of both practical and theoretical medicine. Despite considerable achievements on the basis of highlighted fundamental medicine questions of an etiopatogenesis, it continues to remain not fully elucidated. It is supposed that more thorough investigation skin aging processes can conceptually change our pathological understanding, in this case dystrophic changes of skin of a vulva and vagina. Correction methods remain unresolved, although there is obvious progress in this field.

We investigated the vaginal microbiome of 67 patients with threatened pregnancy using bacterioscopic method and qPCR of vaginal swabs, vaginal pH measurement, and FISH to evaluate desquamated epithelial cells of vagina in urine sediments. Vaginal dysbiosis of women with miscarriage was detected by evaluation of vaginal pH, vaginal swabs bacterioscopy, qPCR in 59,7%, 62,7% and 52,7% of women respectively. Gardnerella vaginalis associated vaginal dysbiosis was determined by qPCR and FISH in 14,9% of women. Enterobacteriaceae in urine sediments were highly presented in women with vaginal dysbiosis (54,8%) and pelvic and/or abdominal cavity inflammatory diseases (46,2%).

This article presents the current data of world literature, highlighting the role of estrogen metabolites and regulation of this process in the pathogenesis of breast diseases.

Patients with hyperplastic processes of the reproductive system, are a special category. At present there is no consensus in the literature on issues of etiology, pathogenesis, early diagnosis, prevention and treatment of this group. The paper analyzes the data of Russian and foreign authors on the pathogenesis of benign mammary dysplasia and endometrial hyperplasia.

There is a strong evidence for identification of key stem cell properties of individual epithelial and stromal cells from human endometrium. These are rare epithelial cells and stromal cells that undergo self-renewal in vitro. The clonally derived epithelial cells differentiate into cytokeratin + gland-like structures, and the stromal cells are multipotent in their capacity to differentiate into adipocytes, chondrocytes and osteoblasts. The epithelial progenitors and the mesenchymal stem cells have the regenerative capacity to restore the endometrium during the menstrual cycle. Further, these cells may even participate in development of pathological conditions such as endometriosis, adenomyosis, endometrial hyperplasia, and endometrial cancer, and also potentially provide a resource for cell-based therapies.

We described vaginal route advantages at gynecologic combined and simultaneous operations. Colpotomy gives possibilities for total hysterectomy, supravaginal hysterectomy by Doderlein-Kronig, myomectomy, ovarectomy and resection, tubes ligation, TVT and TOT variations, genital prolapse correction and preventive maneuvers. Peritoneal adhesive process should not be considered as contraindication to vaginal surgery, in adverse being like potential danger at laparotomy/-scopy. Ample opportunities of uterine mobilisation and manual control give successful operation results possibility even in difficult clinical situations by perfect hemostasis, level-by-level tissues suturing, adequate access to pelvic organs.

The article presents the data of examination and treatment of 102 female patients with hyperplastic processes endometrium.All women have been redistributed on two groups. The first group included patients receiving hormonal therapy, and the second group included patients not receiving hormonal therapy. The analysis of efficiency of treatment of hyperplastic processes endometrium is carried out by hormonal preparations. On the basis of the received data it is possible to draw a conclusion that use of hormonal methods of therapy at patients with hyperplastic processes endometrium yields various results depending on preparations.

The purpose: to determine the physiological alteration of apoptosis at uncomplicated pregnancy and it disorder at spontaneous abortion. 45 pregnant women in gestational age from 6 to 12 weeks divided into 2 groups were investigated: 20 healthy women, wishing were taken as conforms to interrupt pregnancy by a method of a surgical abortion, 25 with spontaneous abortion. Methods: immunofermental method ELIZA (TNF-α, 1L-6), flow cytometric analys with FITS-labelled antibodies (CD-95, annexin V). The results of research have shown that the latent inflammation in endometrium before pregnancy causes the increasing of 1L-6 (probable prenatal infection marker) in the cervical cells from the early term of pregnancy and induces apoptosis with consequent spontaneous abortion.

This review contains recent data on apoptosis. Its main mechanisms are considered, as well as apoptosis regulation at multicellular organism, level association of apoptosis regulation disorders with some diseases. The problems of apoptosis activation and inhibition in connection with the basic regulatory mechanisms of the organism are discussed. It is shown that a programmed cell death is an integrated process depending on correlations between inhibition and activation factors and regulatory intracellular mechanism, insufficient knowledge on this issue calls for further investigation of this process.