The article presents an analysis of scientific studies investigating the effect of autoimmune diseases (AIDs) on the risk of developing cervical intraepithelial lesions, including cervical cancer. 458 scientific publications in foreign and domestic search engines PubMed, Cochrane, and Elibrary were analyzed by keywords and their combinations: "cervical cancer", "autoimmune diseases", "immunosuppressive therapy", "cervical intraepithelial neoplasia", "risk of developing cervical cancer". The final review included 28 articles. The qualitative analysis allowed us to form an idea of the effect of AIDs on the development of intraepithelial neoplastic changes in cervical cancer (CC), in the pathogenesis of which an important place is occupied by the chronic inflammatory process – there is activation of signaling pathways, including NF-kB, JAK-STAT, MAPK and TLR. These agents induce the production of various proinflammatory, tissue-damaging factors, such as cytokines, chemokines, and metalloproteinases. In addition, both in AID and in CC, activated inflammasomes and the signaling pathway of the GMP-AMP interferon synthase stimulating gene (cGAS-STING) are involved in the development of chronic inflammation. It is noted that the C5aR system is associated with carcinogenesis activity and the recruitment of myeloid suppressor cells MDSC, which suppress the antitumor immune response. The presence of immunosuppressive therapy (mainly the use of azathioprine) plays an important role in the progression of intraepithelial changes in the cervix. Several studies present data on the positive effect of vaccination against human papillomavirus (HPV) in patients with systemic lupus erythematosus, while it is recommended to vaccinate against HPV regardless of the presence or absence of this virus in anamnesis. Along with the literature review, the article presents a clinical case of intraepithelial cervical lesion in a patient with systemic lupus erythematosus. Therefore, immunological changes in AIDs in combination with immunosuppressive therapy can contribute to the progression of carcinogenesis. At the same time, it should be noted that when studying this topic, controversial issues remain, which require further development of this problem.

The article presents a systematic analysis of studies evaluating the impact of surgical treatment of benign ovarian tumors on reproductive health, taking into account the criteria stated by the International Classification of Functioning, Disability and Health. To identify articles, foreign and domestic scientific databases were used (PubMed, Cochrane, eLibrary). After the initial identification of 704 scientific publications, 46 articles were selected using inclusion and exclusion criteria.The conducted systemic analysis allows us to formulate the conclusion that surgical interventions performed for benign ovarian tumors contribute to damage to ovarian tissue, and as a result, a decrease in the ovarian reserve of patients, which is associated with impaired fertility. A number of authors have demonstrated some recovery of anti-Mullerian hormone (AMH) levels 3-12 months after surgery. A significant portion of the studies have demonstrated a more pronounced postoperative decrease in AMH rates in patients with endometriomas compared with women operated on for non-endometrioid ovarian tumors. Lower AMH rates were noted in women with bilateral surgeries for bilateral ovarian tumors compared to patients who had unilateral surgeries. The performed systemic analysis showed higher postoperative AMH rates in patients with intraoperative suture hemostasis in comparison with the use of bipolar energy; in addition, there is a relationship between the number of coagulations and the severity of the decrease in AMH rates. In a few studies, it was noted that patients who underwent surgical treatment of ovarian tumors experienced an earlier onset of menopause. In connection with these possible functional disorders, further clinical studies of a high level of evidence are needed, aimed at developing effective strategies for preserving the functioning of the reproductive system after surgical treatment of benign ovarian tumors.

One of the long-term complications of abdominal surgery is endometriosis of the postoperative scar (EPS). The frequency of this condition is 0.03–1.08%. Mechanical implantation of endometrium during primary surgery plays a leading role in the pathogenesis of EPS. Together with clinical manifestations, ultrasound and magnetic resonance imaging are important diagnostic tools for this postoperative complication. Differential diagnosis requires excluding suture granulomas, hematomas, fibroids, hernias, lipomas, seromas, abscesses, and other malignant and benign soft tissue tumors in the area of the scar. This article describes a case of EPS in two women who had undergone cesarean section. Adequate removal of endometrial infiltrates, followed by abdominoplasty, allowed them to avoid recurrence and achieve optimal cosmetic results. Currently, in order to prevent the occurrence of EPS after surgical delivery, it is recommended to change gloves after removing the afterbirth and before restoring the integrity of the anterior abdominal wall, as well as limiting the edges of the wound to the abdominal cavity.

The article describes the main milestones in the labor, scientific and pedagogical activities of Professor Viktor Pavlovich Baskakov, born on November 28, 1923. After graduating from the Military Medical Academy and defending his dissertation for the degree of Candidate of Medical Sciences in 1950, he was hired as a teacher in the Department of Obstetrics and Gynecology, in 1958 he was appointed to the position of associate professor, in 1970 he received the title of professor, after which in 1974 he became head of department, where he worked until 1984. Viktor P. Baskakov was the first in the country to begin studying endometrioid disease. Three of his monographs are devoted to this complex pathology: “Endometriosis” (1966), “Clinic and treatment of endometriosis” (1979, 1990) and “Endometrioid disease” (2002). In 1968, based on the published monograph “Endometriosis” by V.P. Baskakov was awarded the academic degree of Doctor of Medical Sciences without defending a dissertation. For many years, Viktor Pavlovich was a member of the presidium of the Leningrad Obstetrics and Gynecology Society, a member of dissertation councils, and the editorial board of the Journal of Obstetrics and Women’s Diseases. He was awarded the Order of the Red Star and medals, including the medal “For Military Merit” and the medal “For Victory over Germany in the Great Patriotic War of 1941–1945.” Professor Viktor Pavlovich Baskakov remained in the memory of his contemporaries as a talented scientist, teacher, and surgeon. It was difficult to find a person more concerned about the problems of others. Students remember him with a smile and great warmth.

Cervical cancer occupies one of the leading places in the structure of oncological diseases of the Female Reproductive System. In the treatment of this pathology, along with the surgical method of treatment, chemotherapy and radiation therapy are used. According to clinical guidelines, in the presence of cervical cancer stages IIB–IIIA, it is allowed to carry out 2–4 cycles of neoadjuvant chemotherapy in order to create conditions for the possibility of performing extended hysterectomy according to Meigs. Pregnancy during chemotherapy is unique and extremely rare.The article presents a clinical case of pregnancy during chemotherapy (performed according to the scheme: taxanes and platinum-containing drugs) in a 27-year-old patient. According to the clinical picture and results of cervical biopsy, the diagnosis was made: invasive nonkeratinizing squamous cell carcinoma of the cervix IIB (cT2bNxM0) G2, right-sided parametric variant, nonspecific (with unspecified HPV status). Taking into account the presence of parametrial infiltration, the age of the patient, the oncological council prescribed from 2 to 4 cycles of chemotherapy according to the TC scheme (paclitaxel, carboplatin) with an interval assessment. After the second cycle of chemotherapy, an early pregnancy was diagnosed – a medical abortion was performed. Against the background of 3 cycles of chemotherapy, the conditions for surgical treatment were formed – surgical treatment was performed in the amount of extended hysterectomy according to Meigs (type III according to Piver/C2 Morrow) with transposition of the ovaries. The postoperative period was uneventful; the patient was discharged in a satisfactory condition.The described case of pregnancy on the background of chemotherapy is of scientific and practical interest, initiating a discussion on the need to counsel such patients regarding reliable contraception, taking into account the eligibility criteria, which will avoid undesirable outcomes during cancer treatment.

Hematocolpos is a rare pathological condition of the Female Reproductive System. This process is associated with vaginal obstruction and is characterized by a violation of the normal evacuation of secretions from the uterine cavity. This pathology is more often encountered by pediatric gynecologists who diagnose anomalies in the development of female genital organs. In peri- and postmenopausal women obstructive disorders are extremely rare and are associated with hormonal changes or previous interventions.The article presents a rare clinical case of hematocolpos as a result of vaginal carcinoma in postmenopausal woman.

One of the rare variants of uterine smooth muscle tumors is mitotically active leiomyoma, histological characteristics of which are defined by a high number of mitoses in the absence of necrosis and cellular atypia. Despite the presence of mitotic activity, this tumor process is benign. Mitotically active leiomyoma of the uterus is usually diagnosed in patients in the perimenopausal period and its size typically does not exceed 10 cm. This article presents a rare clinical case of a giant-sized mitotically active leiomyoma of the uterus in a woman of reproductive age. Attention is drawn to the challenges in clinical diagnosis and the difficulties in differentiation from malignant neoplasms. The primary treatment method for mitotically active leiomyoma of the uterus is surgical (myomectomy or hysterectomy as indicated). According to several publications, no recurrence of this pathology was observed during patient follow-up after surgical treatment ranging from 6 months to 15 years. Considering the clinical and macroscopic similarity of mitotically active leiomyoma with leiomyosarcoma, careful histological verification of the diagnosis is necessary to determine the correct management strategy.

Postmenopausal osteoporosis is an important interdisciplinary problem of modern medicine. The presented lecture highlights modern approaches to the diagnosis, prognosis and treatment of this pathology. The leading role in the detection of osteoporotic changes is played by radiation diagnostic methods that determine the level of bone mineral density - the equivalent of bone mass. In order to study metabolic disorders of bone tissue, laboratory methods are used that evaluate the activity of bone synthesis and resorption. When predicting osteoporotic fractures, the FRAX model is widely used, which determines the likelihood of fractures in the next 10 years, based on the presence of risk factors. Given the multifactorial nature of the formation of osteoporotic changes, an integrated approach to the treatment of this disease is necessary. According to the recommendations of the European Society of Endocrinology, bisphosphonates should be considered as first-line therapy. Denosumab, romosozumab, teriparatide can be used as second-line drugs. In addition, given the leading role of hypoestrogenism in the development of postmenopausal osteoporosis, the use of menopausal hormone therapy preparations occupies an important place in the prevention and treatment of osteoporotic changes. An important aspect that determines the effectiveness of the treatment of patients with postmenopausal osteoporosis is the need for interaction between doctors of various specialties, including gynecologists, endocrinologists, rheumatologists, traumatologists, doctors of radiation and laboratory diagnostics.

AIM: To study the effect of physical activity on the quality of life of pregnant women at various gestational ages. MATERIALS AND METHODS: An observational cross-sectional study of physical activity and quality of life was performed in 99 pregnant women at various gestational periods. Criteria for inclusion in the study: age 1835 years; absence of acute extragenital pathology; consent to conduct research. Exclusion criteria: age younger than 18 and older than 35 years, the presence of acute extragenital pathology; lack of consent to participate in the study. To assess the physical activity of pregnant women, the international Pregnancy physical activity questionnaire (PPAQ), consisting of 36 questions, was taken as a basis. In order to study the quality of life, an abbreviated methodology of the World Health Organization WHOQOL-26 (World Health Organizations Quality of Life), including 26 questions, was used. RESULTS: To achieve this goal, an adapted Russian-language version of the international questionnaire was developed that determines the level of physical activity in pregnant women PPAQ-RUS, on the basis of which a computer program was created. In the study, data were obtained on the statistically significant effect of a number of parameters of physical activity on the quality of life at various times of the gestational period. The correlation of professional activity with self-perception and the level of physical and psychological well-being, as well as activity associated with physical exercises, indicators of physical and psychological well-being was determined. CONCLUSION: The conducted study can be the basis for further study of the influence of the level of physical activity of pregnant women on the course of the gestational period, as well as the study of the possibility of managing the quality of life of women by changing physical activity depending on the duration of pregnancy.

Endometrial cancer is one of the most common options malignant neoplasms of the female reproductive system. At the same time, in the general structure of female oncopathology, cases of this disease in patients with developmental anomalies of the genital organs are extremely rare. When studying scientific publications, only 26 described clinical cases of uterine cancer in patients with genital malformations were found. The article presents a clinical case of endometrioid carcinoma in a 75-year-old woman with a duplication of uterus. Based on clinical performance, ultrasound investigation results, magnetic-resonance imaging and histological studies of endometrial scrapings was diagnosed duplication of uterus with endometrial cancer IB (cT1вNхМ0), G2 (morphological type endometrioid carcinoma). With this pathology, surgical treatment is considered as the most effective way to fight uterine cancer, in some cases combined with other methods. Both laparotomic and laparoscopic interventions are recommended, provided that pelvic and lumbar lymph node dissection can be performed according to indications. The operation was carried out in the amount of laparotomy, B2 type modified radical hysterectomy, with C3 pelvic lymph node dissection, omentectomy. The result of the postoperative histological examination confirmed the preoperative diagnosis. The postoperative period was without specific findings. The presented rare clinical case demonstrates necessity to give careful attention to patients with a congenital malformation of the genital organs. Timely diagnosis and diagnosis verification will allow for adequate treatment, which will affect the prognosis of survival. At the same time, the prognosis is largely determined by the stage of the process, the depth of the invasive lesion, and the histological type of the tumor.

The study investigated the influence of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 on the reproductive health indicators of cadets of military educational organizations. In the Department of Assisted Reproductive Technologies at the Clinic of Obstetrics and Gynecology of the Kirov Military Medical Academy, 183 male cadets aged 2127 years were divided into two groups and examined. The first group consisted of 132 cadets who had mild and moderate COVID-19, and the second group included 51 cadets without COVID-19 in the anamnesis. COVID-19 was found negatively affect the reproductive health of cadets. Individuals who previously had COVID-19 were found to have a significant decrease in the level of total testosterone and decreased concentration and mobility of sperm in the ejaculate. Moreover, in cadets without COVID-19 who were vaccinated with the combined vector vaccine Gam-COVID-Vac, the indicators of the hormonal profile and spermograms were within the reference values. The results indicate the need for further investigation of the effect of various negative factors, including severe acute respiratory syndrome coronavirus 2, on the reproductive health of cadets of military educational organizations. Moreover, the development of preventive, therapeutic, and rehabilitation measures will reduce the risk of infertility and reproductive losses, which is consistent with the interests of national projects on healthcare and demography.

The article presents a systematic analysis of scientifi c publications concerning the eff ect of combined hormonal contraceptives on the risk of the development of cervical cancer. The following databases were used for literary search: PubMed, Cochrane, Google Scholar, elibrary.ru. Key words and their combinations were: “cervical cancer”, “cervical intraepithelial neoplasia”, “human papillomavirus”, “contraception”, “combined oral contraceptives”, “hormonal contraceptives”. 147 scientifi c publications have been analyzed, and 10 of them have been selected with the use of I/E criteria. Based on the analyzed literature, a conclusion was made. Long-term use of combined oral contraceptives against the background of persistence of the human papillomavirus increases the risk of developing cervical cancer.

One of the most common variants of malignant neoplasms of the female reproductive system is endometrial cancer. At the same time, cases of this disease in patients with genital abnormalities are extremely rare in the general structure of female oncopathology. The article presents clinical cases of endometrioid carcinoma in a 75-year-old woman with doubling of uterus. According to the clinical picture, the results of ultrasound, magnetic resonance imaging and histological examination of endometrial scraping, the following diagnosis was made: cancer of the doubled uterus IB (cT1bNxM0) G2 (morphological type — endometrioid carcinoma). The surgery was performed: laparotomy, modified extended extirpation of the uterus with appendages of level B2 with pelvic lymph node dissection C3, omentectomy. The result of postoperative histological examination confirmed the preoperative diagnosis. The postoperative period was uneventful. The presented rare clinical case demonstrates the need to increase clinical suspicion in relation to patients with abnormalities of the uterus structure. Timely diagnosis and verification of the diagnosis will allow to provide adequate treatment, which will affect the prognosis of survival.

The article is devoted to modern views on the diagnosis and treatment of hyperprolactinemia syndrome in women. Prolactinomas are the leading cause of hyperprolactinemia syndrome. The main clinical manifestations of a pathological increase in the level of prolactin are hypogonadism and galactorrhea, in some cases there are neurological symptoms, as well as psycho-emotional and asthenovegetative disorders. The publication reviews management tactics of patients with prolactinomas and pathological conditions secondary to elevated prolactin levels. Both conservative approaches to the correction of hyperprolactinemia and surgical treatment methods are described. It is noted that at present, drug therapy has priority over surgery. In the medical treatment of hyperprolactinemia, dopamine receptor agonists are used. The duration of therapy with this group of drugs is at least 2 years. The targets should be long-term normalisation of prolactin levels and a significant reduction in the size of the tumour or its absence according to the results of magnetic resonance imaging of the brain. Women with drug-resistant prolactinomas are advised to increase the dose of dopamine receptor agonists to the maximum tolerated dose before considering surgical intervention. Special attention is paid to the management of patients whose pregnancy occurred amid a pathological increase in the level of prolactin. In addition, methods for correcting drug-induced hyperprolactinemia are considered. The long list of drugs that can cause increased prolactin levels shows that the problem of hyperprolactinemia may be encountered by doctors of various specialties. The data presented in the publication are based on clinical guidelines approved by the Russian Ministry of Health and comply with the principles of evidence-based medicine.

This lecture discusses the issues of diagnosis and correction of pathological conditions accompanied by hyperandrogenism in women. The most common causes of a symptom complex caused by an increase in the level of androgens are polycystic ovarian syndrome, congenital dysfunction of the adrenal cortex, endogenous hypercortisolism, androgen-producing tumors. The data presented are based on clinical guidelines approved by the Russian Ministry of Health, consistent with the principles of evidence-based medicine.

Breast cancer is a leader in the structure of oncological pathology of the female reproductive system worldwide. The treatment of this disease is often associated with radical surgery, which inevitably affects the patients' subsequent quality of life. For this reason, it is necessary to practice client-centered approach in choosing the tactics of such patients' management. Surgical methods play a leading role in the treatment of breast cancer, while corrective plastic operations are currently of great importance. The article presents the clinical experience of performing oncoplastic operations for breast cancer. Cases of surgical treatment at various localizations of the oncological process, including performing one-stage reconstructions, have been demonstrated. The author proposes his own reconstruction technique for the superior medial localization of breast cancer. The experience of dealing with such a complication arising after radical mastectomy as lymphorrhea is shown.

BACKGROUND: Due to the active development of molecular genetic diagnostic techniques, much attention is now being paid to the study of intestinal microflora. A number of studies have demonstrated the major influence of the intestinal microbiota on the course of pregnancy. However, the number of publications devoted to this problem is limited. AIM: The aim of the investigation is to assess the qualitative and quantitative composition of the intestinal microflora in pregnant women. MATERIALS AND METHODS: To achieve this goal, 200 pregnant women in the age group 18 to 43 years and with a gestational age of 6 to 22 weeks were examined. A quantitative and qualitative analysis of the microbiocenosis of the vagina and rectum was performed using the real-time polymerase chain reaction method. RESULTS: The results of the study demonstrated the presence of intestinal dysbacteriosis in 100% of pregnant women. Grade I dysbacteriosis was diagnosed in 64.5% of cases, grade II in 26.5% and grade III in 9%. In patients with moderate to severe dysbacteriosis, opportunistic pathogens Enterobacter spp., Clostridium difficile, Campylobacter spp. and Streptococcus spp. in concentrations exceeding formally permissible values. High quantitative indicators of clinically significant opportunistic pathogens in the vaginal biotope were detected amid the decrease in normal flora and a high concentration of opportunistic pathogens in the intestinal biocenosis. Grade II and III intestinal dysbiosis should be considered as a risk factor for the formation of a complicated course of the gestational period in the early stages. CONCLUSIONS: Thus, pregnancy is a predisposing factor to the formation of dysbiotic changes in the intestine. In turn, rational management of intestinal dysbacteriosis can contribute to the correct course of the gestational period in the early stages.

The article summarizes the current knowledge on epidemiology, pathophysiology, and management of patients with peripartum cardiomyopathy. The incidence of peripartum cardiomyopathy varies and largely depends on the geographic region. The overall mortality reaches up to 4-28%. Risk factors for developing peripartum cardiomyopathy include multiple pregnancies and multiple births, family history, smoking, diabetes mellitus, hypertension, preeclampsia, poor nutrition, older or adolescent maternal age, and long-term treatment with beta-adrenergic agonists. Genetic factors play the leading role in the pathophysiology of peripartum cardiomyopathy. It is generally confirmed by family history and the incidence variation depending on the geographical region. The pathogenetic role of vasoinhibin, an isoform of prolactin, is described. Vasoinhibin has antiangiogenic, proapoptotic, proinflammatory, and vasoconstrictor effects. The important role of an imbalance between angiogenic and antiangiogenic factors is discussed. There are no guidelines for obstetricians and gynecologists on the management of pregnant women, parturient women, and postpartum women. One of the reasons is the absence of evidence. An urgent cesarean section is indicated if the pregnant woman has acute heart failure and requires inotropic support and/or invasive therapy. However, 2018 ESC Guidelines for the Management of Cardiovascular Diseases during Pregnancy recommend vaginal delivery in these patients.

Aim. To study reproductive health of women with and without eating disorders. Materials and Methods . We designed an original questionnaire, surveyed and analyzed the medical records of 200 women of reproductive age. Results . All the study participants suffered from eating disorders. Out of 200 patients, 46 (23%), 120 (63%), and 34 (17%) had emotional, restrictive, and external eating disorders, respectively. Women with normal body mass index (BMI) or overweight were more likely to have an avoidant/restrictive food intake disorder while emotional and external types prevailed among obese patients. Fibrocystic breast changes, uterine fibroids, polycystic ovary syndrome, infertility, and breast cancer were significantly more common in women with obesity (r = 0.74 for gynecological diseases in total). Pelvic inflammatory disease was more frequently diagnosed in women with emotional eating disorders while fibrocystic breast changes, uterine fibroids, and polycystic ovary syndrome were more prevalent in those with restrictive food intake disorder. Breast cancer prevailed in women with external eating disorders. Conclusion . Women of reproductive age are frequently diagnosed with different types of eating disorders. Obese women are more likely to have reproductive system disease. Each of eating disorders correlate with different gynecological diseases.

Annually, there > 30,000 infants are born with congenital heart defects; in different populations, the prevalence of congenital heart disease (CHD) varies from 2.4 to 14.15%. Women with CHD planning pregnancy are at increased risk of heart failure, arrhythmias, cerebrovascular disease, and embolism. In such patients, pregnancy course is complicated by intrauterine growth restriction, pre-eclampsia, and preterm birth. Their newborns generally have a low birth weight and high risk of congenital malformations including heart defects. European Society of Cardiology (ESC) developed risk assessment-based guidelines to optimise the management of pregnant women with CHD. This approach requires a cooperation of obstetrician-gynecologists, general practitioners, and cardiologists.