Objective. To study the course of multiple pregnancy after the use of different methods of assisted reproductive technologies. Patients and methods. A total of 234 patients with multiple pregnancy developed through in vitro fertilization (IVF) were examined: 99 patients under the surrogate motherhood program (IVF-SM), 68 women after IVF with donor oocytes (IVF-DO), and 67 patients after IVF with own oocytes (IVF-OO). Patient subgroups were formed based on the presence or absence of obstetric complications. Results. Univariate analysis of pregnancy course showed that the incidence of gestational hypertension was significantly higher in the IVF-DO group than in the IVF-SM and IVF-OO groups. Pre-eclampsia (PE) in patients in the IVF-DO group was significantly more common than in the IVF-SM group (OR: 5.87; 95% CI: 1.94–17.74, p < 0.0005). Intrahepatic cholestasis (11.7%) and gestational diabetes (7.3%) were also more common in the IVF-DO group, but these data were not statistically significant. In multivariate analysis adjusted for maternal age, the incidence of PE remained significantly higher in the IVF-DO group compared with the IVF-SM group (OR: 7.68; 95% CI: 1.64–35.84, p < 0.0055). There were no significant differences between the IVF-DO and IVF-OO groups (OR: 2.8; 95% CI 0.77–10.22, p < 0.1487) and the IVF-OO and IVF-SM groups (OR: 0.36; 95% CI 0.11–1.24, p < 0.1305). Conclusion. Multiple pregnancy following IVF-DO is significantly associated with a higher risk of pre-eclampsia and fetal growth restriction compared with the IVF-OO and IVF-SM groups. Key words: multiple pregnancy, oocyte donation, pre-eclampsia, surrogacy, in vitro fertilization

Objective. To study the efficacy and safety of anti-cytomegalovirus hyperimmune globulin for the prevention of congenital cytomegalovirus (CMV) infection. Materials and methods. A search for relevant studies in three major databases revealed 990 articles: 504 in PubMed, 18 in Cochrane Library, and 468 in ClinicalTrial.gov. Of the initially identified search results, 10 articles were analyzed. Conclusion. The available data are insufficient to recommend the use of hyperimmune globulin to prevent vertical transmission of cytomegalovirus; further studies are needed to obtain more information on the possibility of prevention and treatment of congenital CMV infection. Key words: congenital cytomegalovirus infection, anti-cytomegalovirus plasma, hyperimmune globulin, pregnancy, cytomegalovirus

This article presents a pilot study of surgical correction of isthmic-cervical insufficiency (ICI) in 5 patients aged 29 to 45 years with singleton pregnancies at gestational ages ranging from 13–14 to 19–20 weeks. An original method of cerclage using a spiral suture, anchor ligatures, and a titanium fixator was developed, the main purpose of which is to prevent cervical injury by the erupting suture of the terminal fixing block of the anchor ligature. This method of ICI correction is expected to contribute to optimization of the results of surgical treatment and improvement of perinatal outcomes. Key words: isthmic-cervical insufficiency, anchor ligatures, titanium fixator, cerclage, spiral suture

Objective. To analyze the rate and pattern of preterm birth in multiple pregnancy after in vitro fertilization (IVF) using donor and autologous oocytes. Patients and methods. The rate of preterm birth in 213 women with a dichorionic diamniotic twin pregnancy was analyzed. All patients were divided into three groups: IVF-DO – 68 women who became pregnant after IVF with donor oocytes, IVF-AO – 73 women who became pregnant after IVF with autologous oocytes, and NTP – 72 women with natural twin pregnancy. The study included only those women whose pregnancy resulted in birth. Results. Most of the patients in the IVF-DO group were over 40 years of age, while the other groups were dominated by women under 35 years of age. There was no statistically significant increase in the overall rate of preterm birth in the IVF groups compared to the NTP group. However, pregnancy termination before 34 weeks’ gestation was significantly more frequent in patients in the IVF-DO group (OR = 3.28; 95% CI = 0.99–10.86). There were also significantly higher rates of pregnancy complications such as pre-eclampsia (PE) (OR = 10.42; 95% CI = 2.94–36.94), gestational hypertension (GH) (OR = 11.16; 95% CI = 3.16–39.43), intrahepatic cholestasis of pregnancy (ICP) (OR = 4.67; 95% CI = 0.95–22.82), and placental abruption (PA) (OR = 9.47; 95% CI = 1.15–77.86) in the IVF-DO group. Conclusion. Multiple pregnancy after IVF with donor oocytes include a combination of several significant and age-independent risk factors for preterm birth. Key words: preterm birth, IVF, oocyte donation, multiple pregnancy, twins

The amniotic membrane (AM), or amnion, is the innermost layer of the placenta; it surrounds the embryo and delimits the amniotic cavity, which is filled with amniotic fluid. The use of AM in various medical areas has been increasing in recent years due to its extracellular matrix structure, presence of stem cells, and biological properties that improve both wound healing and tissue regeneration. The amnion also possesses antimicrobial, anti-inflammatory, antifibrotic, and antiangiogenic properties. It does not cause immune reactions, and its use does not raise ethical concerns. This review describes the application of the membrane in ophthalmology, dermatology, gynecology, and other fields. The membrane can be used as either a whole tissue or a matrix for stem cell culturing in vitro. The review also discusses the results of using amnion epithelial and mesenchymal stem cells in the therapy for Parkinson’s disease, diabetes, and fibrosis due to myocardial infarction. Conclusion. AM has many properties that prevent scar formation, reduce inflammation, and promote wound healing. Due to these properties, AM is used in many fields of medicine, and further studies on its structure, functions and properties will undoubtedly reveal new areas of clinical application. Key words: amnion, amniotic membrane, human amniotic mesenchymal stem cells, human amniotic epithelial stem cells, amniotic membrane transplantation

This article presents a new method of uterine closure in repeat cesarean section using absorbable suture anchors and additional sealing of the scar with amniotic membrane. The proposed method is not followed by excessive blood loss, does not prolong the duration of surgical intervention and postoperative hospitalization. This method also reduces the incidence of intra- and postoperative complications and cesarean scar defect, eliminates the need for additional hemostatic suturing of the uterus, and promotes myometrial regeneration. Key words: amnion, amniotic membrane, cesarean section, cesarean scar defect

This article presents a clinical case of successful organ-preserving surgical treatment of giant uterine leiomyoma in a 29-year old patient. The tumor had an average diameter of 35 cm and was localized in the posterior uterine wall and cervical-pericervical region. The following procedures were performed: midline laparotomy, temporary occlusion of the internal iliac arteries, myomectomy with uterine cavity dissection, endometrial biopsy, and metroplasty. Key words: giant leiomyoma, myomectomy, reproductive potential, temporary vascular occlusion

This article presents a clinical follow-up of a 41-year-old patient with the recurrence of deep infiltrating endometriosis affecting the urinary tract. A multidisciplinary approach to examination and treatment contributed to the successful outcome of laparoscopic surgery, which included adhesiolysis, resection of the left ovary, excision of endometrioid infiltrates in the left parametrium, rectovaginal septum and vagina, posterior wall of the urinary bladder, left ureterocystostomy. The dynamic 6-month follow-up revealed no signs of recurrence of the disease and upper urinary tract dilatation, which made it possible to start preparing for next pregnancy. Key words: recurrence of deep infiltrating endometriosis, multidisciplinary approach, laparoscopy, excision of multifocal endometrioid infiltrates, ureterocystostomy

The clinical observation of ovarian pregnancy in a 29-year-old patient with newly identified ovarian and peritoneal endometriosis, which is considered as a risk factor for ectopic pregnancy in the literature, is presented. This observation proves that ovarian pregnancy presents significant difficulties for the diagnosis: in our study, the diagnosis was established only during laparoscopy. The ovarian resection and the excision of the endometriotic foci were performed, which subsequently contributed to the onset of pregnancy with a favorable outcome – emergency delivery. Key words: ovarian pregnancy, endometriosis, surgical treatment

Objective. To study the characteristics of oximetry and electrolyte balance of umbilical cord arterial and venous blood in newborns with fetal growth restriction. Patients and methods. Laboratory analysis of oximetry and electrolyte balance in blood samples from the umbilical artery and vein in 40 newborns after vaginal delivery at term and uncomplicated pregnancy (the control group) and in 30 newborns with fetal growth restriction after vaginal delivery at term (the study group) was performed. Results. The analysis revealed that the levels of FHbF, pO2, sO2, FO2Hb, FCOHb, cCa2+ and ctO2 in umbilical cord venous blood in the study group were significantly higher than in the control group, while the levels of pCO2, p50, FHHb were significantly lower (p < 0.05). The comparative evaluation of pH, Hct, ctHb, cK+, FMetHb, cNa+, cCl–, mOsm showed no differences between the groups (p > 0.05). The levels of pCO2, FHbF, pO2, sO2, FO2Hb, FCOHb and ctO2 in umbilical cord arterial blood in the study group were significantly higher than in the control group, while the levels of p50, FHHb were significantly lower (p < 0.05). The comparative evaluation of pH, Hct, ctHb, FMetHb, cNa+, сК+, сСа2+, cCl–, mOsm showed no differences between the groups (p > 0.05). Conclusion. Statistically significant differences between the parameters of oximetry and electrolyte balance of umbilical cord arterial and venous blood in fetal growth restriction provide additional information for objective assessment of the newborn’s physical condition. Key words: blood gas analysis, umbilical cord arterial and venous blood, gas-electrolyte composition, gas analyzer, fetal growth restriction, umbilical cord blood oximetry

Objective. A comparative analysis of the immediate and long-term outcomes of total and subtotal hysterectomy with excision of the mucosal and muscular layers of the cervix in patients with benign uterine diseases. Patients and methods. A total of 366 patients aged 41 to 57 years were examined. Patients were divided into two groups: the study group (n = 254), which included patients who underwent laparovaginal subtotal hysterectomy with excision of the cervical mucosal and muscular layers using a modified cutting instrument (surgical cutter), and the comparison group (n = 112), which included patients who underwent total hysterectomy. All operations were performed by a laparoscopic approach. The duration of postoperative outpatient follow-up was 1–48 months. Results. In 88.6% of patients in the study group, there were no pronounced vegetative-vascular and psycho-emotional disorders, exacerbation or worsening of chronic somatic diseases; 56.3% of patients in the comparison group had clinical manifestations of the post-hysterectomy syndrome. Deterioration in the quality of sexual life (reduced libido and/or anorgasmia) was observed in 9.4% and 36.6% of women in the study and comparison groups, respectively. Vaginal vault prolapse was revealed in 3.6% of patients in the comparison group and vaginal vault granulation – in 4.5% of patients 2-3 years after surgery. No similar complications were registered in the study group. Conclusion. Subtotal hysterectomy with excision of the cervical mucosal and muscular layers using the presented technique can serve as an alternative to total hysterectomy in patients with benign uterine pathology. Preservation of the uterine suspensory apparatus, innervation, and blood supply of the cervical stump and the upper third of the vagina reduces the risk of pelvic floor anatomical and functional disorders and minimizes the possibility of post-hysterectomy pelvic organ prolapse. The proposed method of hysterectomy helps to reduce the duration of surgery, blood loss, the risk of intra- and postoperative complications, to minimize the development of cervical stump diseases and improve patients’ quality of life. Key words: subtotal hysterectomy, total hysterectomy, cervical mucosal and muscular layer excision, laparoscopy, surgical cutter, post-hysterectomy syndrome

Objective. To study the course and outcome of labor in patients who are at high risk of pre-eclampsia (PE), fetal growth restriction (FGR), preterm birth (PB), and fetal chromosomal abnormalities (CA) according to the results of prenatal screening. Patients and methods. We performed a prospective analysis of the course of labor in 443 women with singleton pregnancy who underwent the first trimester prenatal risk assessment based on the Astraia program. Group 1 (n = 235) included highrisk subgroups for CA – 1A (n = 69); PE – 1B (n = 66); FGR – 1C (n = 48); PB – 1D (n = 52). Risk combinations were excluded, and one of the four assessed outcomes was considered. Group 2 (control group, n = 208) was comprised of lowrisk women. Results. The risk of PB (>34 and <37 weeks) was higher in group 1 than in group 2 (р < 0.05). Full-term birth in both groups had no differences (р > 0.05). Post-term birth was more common in group 2 (р < 0.05). Labor induction prevailed in group 1 and subgroups 1B, 1C (р < 0.05). Labor complications were more common in group 1 (р < 0.05). Prelabor rupture of membranes was more frequent in the subgroups 1B and 1D of group 1 (р < 0.05). Fetal distress and a combination of complications (distress, weak contractions, and rupture of membranes) prevailed in group 1 (p < 0.05). Cesarean section was performed more frequently in group 1 than in group 2 (р < 0.05). Indications in group 1 were placental insufficiency (PI) and PE (р < 0.05). The dif-ference in the frequency of PI between subgroups 1C and 1B was significant relative to 1A, 1D (р < 0.05). Fetal distress was noted in one third of both groups and subgroup 1C (р > 0.05). Conclusion. In the high-risk group based on the results of prenatal screening compared with the control group, there was a significantly higher frequency of prelabor rupture of membranes (in subgroups 1B (PE), 1D (PB)), fetal distress, and a combination of complications, as well as cesareans delivery (subgroups 1B (PE) and 1C (FGR)) (р < 0.05). Key words: fetal distress, labor induction, labor complications, prenatal screening, risk level

According to the World Health Organization, there are about 5.9 million annual perinatal deaths worldwide, the etiology of which, on average, remains unspecified in 15–50% of cases. This review presents an analysis of the existing classification systems for causes of perinatal mortality, estimates the current data on risk factors and possible pathophysiological mechanisms of sudden fetal and infant death, identifies several world health problems that prevent the reduction of stillbirth and neonatal mortality rates, and suggests the ways of their solution. Key words: perinatal mortality, stillbirth, sudden intrauterine death syndrome, brainstem, cardiac conduction system

The tumor lesions of the reproductive system organs carry the leading position in the structure of gynecological diseases. One of the rare tumors that can affect the organs of the reproductive system is pecoma, which is a tumor of mesenchymal origin. Because of it’s rare occurrence the gynecologists often misinterpret available clinical data and the results of patient`s examination, diagnosing and treating the tumor as a myoma before having received the results of the histological examination. Our article describes a clinical case of a patient who had a preliminary diagnosis of uterine fibroids, and because of this fact the planned surgical treatment was carried out. But a retroperitoneal tumor originating from the uterine vein was detected during the surgery. The diagnosis of sclerosing pecoma was established by histological and immunohistochemical studies. The article analyzes the clinical features of the patient`s disease, as well as the available results of instrumental methods of examination which can lead to final diagnosis of pecoma, also difficult issues of diagnosis and tactics of diagnostic search are noted.The literature data on the frequency of detection of pecomas, the features of their structure are presented. It is marked, that there is also a possibility of pecoma`s localization in various organs, for example, lungs, liver, kidneys, as well as in soft tissues. The possibility of multiple lesions – pecomatosis is emphasized. It is noted that among the pelvic organs the uterus is affected most often, but furthermore, the pelvic lymph nodes, the broad ligament, the omentum, the peritoneum of the pelvis and the rectum wall can be also involved in the pathological process. Risk factor of pecomas malignancy is discussed separately, the presence of three types of pecomas is determined. This fact significantly effects the probability of relapse of the tumor after surgical removal and, respectively, the tactics of postoperative follow‑up of such patients.

Objective. To study and systematize the results of ethanol sclerotherapy in patients with ovarian endometriomas and perform a comparative analysis of the efficacy of sclerotherapy and cystectomy according to international research publications. Materials and methods. Electronic searching was conducted through Medline, PubMed, Google Scholar, ClinicalTrials, and Cochrane Library databases for cohort studies and randomized controlled trials only. A systematic review was performed using preferred reporting items for systematic reviews and meta-analyses (PRISMA). A total of 626 articles were reviewed. The Cochrane Collaboration’s tool was used to assess the quality of the studies. Results. It was shown that ethanol sclerotherapy for ovarian endometriomas bears the lowest risk in terms of surgical complications; it is highly economical in combination with maximum fertility preservation, which is especially relevant in assisted reproductive technology programs. The effectiveness of this method is largely determined by the conditions for its use, as well as by the time of ethanol exposure (optimally not less than 7 minutes). At the same time, ethanol puncture of endometrial cysts is not a monotherapy, and its outcome is greatly influenced by the adequacy of postoperative hormonal treatment. The use of 30 μg ethinylestradiol + 2 mg dienogest was shown to be promising. Conclusion. Ethanol sclerotherapy for ovarian endometriomas should be performed in accordance with the developed conditions and indications for its use in combination with postoperative hormonal treatment. Key words: endometriosis, ovarian endometrioma, sclerotherapy, cystectomy, ethinylestradiol + dienogest

Objective. To study the efficacy of different treatment options for patients with intrauterine synechia. Patients and methods. The results of the observation and treatment of 1218 patients of reproductive age with intrauterine synechia and Asherman’s syndrome were analyzed. Patients were retrospectively divided into 4 groups depending on the treatment option (mechanical dissection of synechiae, laser destruction without or under ultrasound or laparoscopic control). Results. The role and diagnostic value of office hysteroscopy for determining treatment tactics were defined; high efficacy of complex treatment (laser surgery, anti-adhesion gels, postoperative care and rehabilitation) for patients with uterine factor infertility was established: there was no relapse in 98% of patients, and pregnancy occurred in 57% of patients. Intraoperative ultrasound monitoring of patients with Asherman’s syndrome allowed to avoid intraoperative complications in all patients; menstrual cycle was restored in 97.5%, pregnancy occurred in 24%, repeated intervention was necessary in 18%. Conclusion. A comprehensive method including hysteroscopy, laser destruction of synechiae, administration of anti-adhesion gels, postoperative laser therapy, and rehabilitation with the use of chlorophyll-containing medications allows to achieve high efficacy in the treatment of patients with uterine infertility caused by intrauterine synechiae. The results of the analysis indicate the advisability of intraoperative ultrasound monitoring in the surgical treatment of Asherman’s syndrome. Key words: intrauterine synechiae, Asherman’s syndrome, laser destruction, uterine factor infertility

Objective. To compare the efficacy of different methods of surgical correction of isthmocele after caesarean section. Patients and methods. The study included 56 patients aged 29–41 years, who were divided into three groups: group 1 (n = 16) – patients who underwent surgical laparoscopy with suturing the uterine wound with single-row separate muscularmuscular sutures; group 2 (n = 23) – patients after repair of the uterus with a double-row continuous seromuscular and muscular-muscular suture performed by laparoscopy; group 3 (n = 17) consisted of patients who underwent laparotomy and suturing the uterine wound with a double-row continuous suture. Results. We developed a three-stage plastic and reconstructive surgical laparotomic and laparoscopic program in case of the uterine scar incompetence, which improved the quality of life in all patients. Pregnancy occurred 9–14 months after plastic and reconstructive surgery on the uterus and resulted in timely surgical delivery in 4 (25%) patients in group 1, in 7 (30.4%) patients in group 2 and in 3 (17.6%) patients in group 3. Two (12.5%) patients in group 1 and three (13.04%) patients in group 2 were observed during pregnancy with a period of 10–28 weeks. Conclusion. The use of laparoscopy ensured better visualization of anatomical structures (vessels, nerves, ureters, bladder), which led to a decrease in intraoperative blood loss, in the risk of damage to adjacent organs and in the development of adhesions, and to accelerated postoperative rehabilitation of patients. Key words: double-row suture, istmocele, laparoscopy, metroplasty

Objective. To study the efficacy and safety of the original technique for surgical correction of cervical elongation with vaginal wall prolapse (stage I–II) in patients of reproductive and menopause age. Patients and methods. The study included 17 patients aged 30 to 56 years with cervical elongation and vaginal wall prolapse. All patients underwent the original surgery – cervical amputation along with combined transobturator and sacrospinous TiMeshligature cervical suspension. Results. The patients were observed 1, 6, 12 and 18 months after surgery. Comparison of the patients’ questionnaire data in the pre- and postoperative periods showed an improvement in their quality of life, an increase in their social and sexual activity. During the first month, 10 (58.8%) patients noted intermittent episodes of perineal pain and 3 (17%) – frequent urination. Comprehensive clinical examination after 6, 12, and 18 months revealed complete preservation of surgical correction of prolapse in all patients. Gynecological and rectal examinations, transperineal and transvaginal ultrasound revealed no displacement of pelvic organs and titanium implants. There were no mesh-associated complications during follow-up. Conclusion. The developed original technique for surgical correction of cervical elongation with vaginal wall prolapse (stage I–II) using a combination of titanium mesh implants and non-absorbable ligatures with two-lateral suture anchor was shown to be effective and safe, as evidenced by normalization of the uterus position in the pelvis and absence of pelvic organ displacement and mesh-associated complications during follow-up. Key words: cervical elongation, stage I–II vaginal wall prolapse, titanium mesh implants, mesh-ligature correction of prolapse

A clinical case of management of a pregnant woman (surrogacy) with dichorionic triamniotic triplets, self-reduction of one fetus from triplets in the gestation period of 13 weeks, intrauterine death of the second fetus at week 20 of pregnancy and delivery of the third live fetus in full-term pregnancy. Key words: surrogacy, triplets, multiple pregnancy, intrauterine fetal death, immunological tolerance