The development of National clinical guidelines on diagnosis and treatment of Ph-negative myeloproliferative neoplasms provides the knowledge basis for decision making in diagnosis, therapy, prevention, and rehabilitation in compliance with evidence-based medicine principles in order to ensure appropriate medical care in a particular clinical setting. The clinical guidelines underly the choice of optimal methods of diagnosis, therapy, prevention, and rehabilitation as part of a patient’s medical care, the development of criteria for the assessment of medical care quality, medical care standards, medical care procedures, setting standards on equipment and management of diagnostic and therapeutic procedures, and provision of continuous medical education and advanced training for healthcare professionals. In 2013, a working group was formed to develop and formulate clinical guidelines on the treatment of myeloproliferative neoplasms. These guidelines were first published in 2014, afterwards they were revised and republished. The dynamic development of current hematology presupposes constant updating of knowledge and implementation of new diagnosis and treatment methods in clinical practice. In this context, clinical guidelines present a dynamic document to be continuously amended, expanded, and updated in accordance with scientific findings and new requirements of specialists who are directly involved in treatment activities. The present edition is an upgraded version of clinical guidelines with updated information on classification, diagnosis, prognosis, current methods of therapy, and their efficacy and tolerability assessment. The guidelines are intended for oncologists, hematologists, healthcare executives, and medical students.

BACKGROUND:The concern of the global community of gynecologists and obstetricians (FIGO) regarding the increase in the number of caesarean sections has resulted in the creation of a new classification, Placenta Accreta Spectrum (PAS), which presents degrees of villus invasion into the uterine wall.OBJECTIVE:Compare the main types of atypical placentation (AP) with the stages of PAS, to supplement and unify the clinical and morphological criteria AP.MATERIAL AND METHODS:Surgical material was examined from 73 women after metroplasty (n=61) and hysterectomies (n=12) from the regions of Russia, Moscow and the Moscow region for ingrown villi and from 10 women with a typical placenta location during the first cesarean section. A targeted cutting of material from the uteroplacental region was used, at least 10-12 pieces, with further H&E and Mallory staining.RESULTS:In the classification of AP, the terms «placenta accreta», «increta», «percreta» should be retained. It is necessary to single out pl. previa as a separate type. Attention is focused on the need to assess the depth of villi invasion accompanied by a layer of fibrinoid, the volume of scar tissue and the degree of disorganization of the myometrial bundles, the state of the vessels in the serous membrane. A new type of AP has been proposed - a sharp thinning of the lower segment of the uterus, due to the scar failure and the pressure of the growing amniotic sac, leading to atrophy and necrosis of the myometrium.CONCLUSION:An integrated approach should be used to classify atypical placentation, taking into account not only the depth of villus invasion, but also anatomical and pathogenic factors in order to develop targeted methods of surgical treatment.

Authors discuss the problem of influenza in pregnant, the risk of severe influenza infection with an increase in gestational age, the effect of infection on the fetus, which leads to premature birth, stillbirth. A review of the literature on the development of the vaccination program for pregnant worldwide since the end of the 20th century is given focusing on the effectiveness and safety of influenza vaccination for the pregnant and the fetus.

On December 18, 2022, an interdisciplinary Expert Council was held in St. Pe­ter­sburg, dedicated to the debatable issues of anticoagulation in the prevention of venous thromboembolism in pregnant women with cardiovascular and systemic diseases, at which a number of proposals and guidelines were adopted, and the results of the Highlow study were considered. Leading experts from the Russian Society of Cardiology, the Russian Society of Obstetricians and Gynecologists, the National Association of Specialists in Thrombosis, Clinical Hemostaseology and Hemorheology took part in the Expert Council.

The COVID-19 pandemic has raised questions about indirect impact in pregnant women on the development of their future children. Investigating the characteristics of lipid metabolism in the “mother–placenta–fetus” system can give information about the pathophysiology of COVID-19 infection during pregnancy. A total of 234 women were included in study. Maternal plasma, cord blood, and amniotic fluid lipidome were analyzed using HPLC-MS/MS. Differences in lipid profile were searched by Mann–Whitney and Kruskall–Wallis test, and diagnostic model based on logistic regression were built by AIC. Elevated levels of lysophospholipids, triglycerides, sphingomyelins, and oxidized lipids were registered in patients’ maternal and cord plasma after COVID-19 infection. An increase in maternal plasma sphingomyelins and oxidized lipids was observed in cases of infection during the second trimester. In amniotic fluid, compared to the control group, nine lipids were reduced and six were elevated. Levels of phosphoglycerides, lysophosphoglycerides, and phosphatidylinositols decreased during infection in the second and third trimesters of pregnancy. A health diagnostic model for newborns based on maternal plasma was developed for each group and exhibited good diagnostic value (AUC > 0.85). Maternal and cord plasma’s lipidome changes during delivery, which are associated with COVID-19 infection during pregnancy, are synergistic. The most significant disturbances occur with infections in the second trimester of pregnancy.

ДИАГНОСТИКА ВРАСТАНИЯ ПЛАЦЕНТЫ С ИСПОЛЬЗОВАНИЕМ СИСТЕМЫ MAPI-RADS С ЦЕЛЬЮ ОПРЕДЕЛЕНИЯ ПРЕДИКТОРОВ МАССИВНЫХ КРОВОТЕЧЕНИЙКулабухова П.В

Background: Peripartum management of women using low-molecular-weight hep-arin (LMWH) varies widely. Minimum time intervals are required between LMWH injection and neuraxial procedure, and they differ by dose.Objectives: The objective of this study was to describe the onset of labor and use of analgesia in women using LMWH and to compare practices between intermediate -dose and low-dose LMWH.Methods: In the Highlow study (NCT 01828697), 1110 women were randomized to intermediate-dose or low-dose LMWH and were instructed to discontinue LMWH when labor commenced unplanned or 24 hours prior to planned delivery. The required time interval since last injection to receive a neuraxial procedure was >= 24 hours for intermediate-dose LMWH or >= 12 hours for low-dose LMWH.Results: In total, 1018 women had an ongoing pregnancy for >= 24 weeks. Onset of labor was spontaneous in 198 of 509 (39%) women on intermediate-dose LMWH and in 246 of 509 (49%) on low-dose LMWH. With unplanned onset, a neuraxial procedure was performed in 37% on intermediate-dose and in 48% on low-dose LMWH (risk difference -11%, 95% CI -20% to -2%). Based on time interval, 61% on intermediate-dose and 82% on low-dose LMWH were eligible for a neu-raxial procedure. With planned onset, 68% on intermediate-dose and 66% on low -dose LMWH received a neuraxial procedure, whereas 81% and 93%, respectively, were eligible for a neuraxial procedure (risk difference -13%, 95% CI -18% to -8%).Conclusion: With spontaneous onset of labor, neuraxial procedures were performed less often in women using intermediate-dose LMWH. Irrespective of onset, fewer women on intermediate-dose LMWH than those on low-dose LMWH were eligible for neuraxial procedures based on required time intervals since the last LMWH injection.