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

Ovarian vein thrombosis (OVT) is a rare but potentially serious complication associated with a variety of conditions, including past childbirth, inflammatory diseases, malignant processes, and pelvic surgery. The aim of this study is to summarize the literature on this problem and to analyze the frequency, differential diagnosis, and management of OVT. The article highlights three observations of ovarian vein thrombosis and thrombophlebitis diagnosed after spontaneous and operative vaginal deliveries. Key words: pregnancy complications, postpartum period, thrombosis, thrombophlebitis, ovarian vein

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

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

The aim of this research was to analyze the literature on uterus transplantation. The features of the preoperative preparation were presented: recipient and donor selection, surgical aspects of uterus transplantation, postoperative complications and rehabilitation period management, choice of immunosuppressive medications. Special attention was paid to the restoration of fertility and reproductive function in uterus recipients. The results of uterus transplantation from a living donor and a deceased donor in different countries of the world – Germany, USA, Brazil, China were studied. The study shows that although the number of uterus transplants has reached 52 by 2021, this procedure is still not routine and is experimental. Key words: infertility, Mayer-Rokitansky-Küster-Hauser syndrome, uterus transplantation

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 analysis of literature data on molecular mechanisms for remodeling of connective tissue of the female reproductive system during pregnancy, childbirth and in the postpartum period is presented. The search for publications and their analysis was conducted in PUBMED, Google Scholar, eLIBRARY.RU databases. Particular attention was given to the study of expression pattern of specific proteinases involved in the process of synthesis and combination of elastic fibers, assembly of the collagen polypeptide chains at different stages. The place of matrix metalloproteinases and their tissue inhibitors in proteolytic degradation of the extracellular matrix of connective tissue is described. Pregnancy, childbirth and postpartum period are the triggering mechanism for connective tissue remodeling, certain mechanisms of which remain unclear and require further investigation. Key words: collagen, lysyl oxidase, metalloproteinases, сonnective tissue, fibulin-5, extracellular matrix, elastic fibers

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

Проведение доклинических исследований для оценки безопасности и эффективности лекарственного средства является необходимым условием для его регистрации и внедрения в клиническую практику. Успех данных исследований во многом зависит от выбора животного и способа моделирования определенной патологии. В представленном обзоре методов анализируются данные по моделированию гинекологической патологии на лабораторных животных. В частности, рассмотрены методы воздействия, позволяющие моделировать синдром Ашермана, эндометриоз и хронический эндометрит. Поиск исследований производился в электронной библиотеке PubMed и базe клинических исследований Clinical Trials. В работе приводится характеристика использующихся хирургических вмешательств, физических, химических и инфекционных методов нарушения целостности матки и формирования в органе воспалительного и спаечного процессов. Рассматривается возможность моделирования эндометриоза при помощи стрессового воздействия. Оценена эффективность применения данных стратегий и возможность их дальнейшего использования. Анализ литературы показал, что наиболее оптимальным вариантом для моделирования повреждения матки считается использование крыс-самок в возрасте от 5 до 8 нед. Наиболее воспроизводимым способом имитации патоморфологических механизмов внутриматочной адгезии является повреждение эндометрия 95-процентным этанолом. Наиболее универсальным способом моделирования хронического эндометрита считается подшивание участков эндометрия к париетальной брюшине передней брюшной стенки. Preclinical studies are performed to assess safety and efficacy of a drug. They are a prerequisite for drug registration and implementation. Success of these studies depends on the choice of the animal and the method of modeling the pathology. This review focuses on modeling gynecological pathologies in preclinical studies. Specifically, the authors addressed experimental impacts for modeling Asherman’s syndrome, endometriosis, and chronic endometritis. The search for literature was conducted in PubMed and Clinical Trials databases. The review describes surgical interventions, physical, chemical, and infectious methods for affecting the uterus integrity and induction of inflammatory and adhesive processes in this organ. A possibility of modeling endometriosis by stress exposures is considered. Effectiveness of these strategies and prospects for their future use were evaluated. According to the analysis of reports the most suitable animal for modeling the uterine damage is 4-8-week-old female rats. The most reproducible way to activate mechanisms of pathomorphological intrauterine adhesion is chemical injury of the endometrium with 95% ethanol. The best approach in modeling chronic endometritis is endometrial and parietal peritoneum stitching.

Objective. To evaluate the prevalence of vaginal carriage of Streptococcus agalactiae among pregnant women at 35–37 weeks of gestation and assess the efficacy of intrapartum antibiotic prophylaxis (IAP) for group B streptococcus (GBS) infection in newborns. Patients and methods. We examined 800 pregnant women at 35–37 weeks of gestation (bacteriological examination of vaginal microbiota with biomaterial collected from the posterior vaginal fornix). Identified carriers of S. agalactiae who had vaginal delivery (n = 50) received antibiotic prophylaxis to prevent infection in newborns. We also evaluated the frequency of vertical transmission of streptococci in all infants during the first hour of life (bacteriological examination of pharyngeal swabs and meconium). Identification of microorganisms was performed by direct protein profiling using MALDI-TOF mass spectrometry (FLEX series, Bruker Daltonic GmbH, Germany). Results. Maternal vaginal colonization with S. agalactiae in the third trimester was observed in 13.5% of patients tested (n = 108). Fifty women had vaginal delivery and received antibiotic prophylaxis to prevent infection in newborns. Postpartum samples of only 1 newborn gave scanty growth of S. agalactiae at bacteriological examination (1 × 101 CFU/mL in meconium and 1 × 103 CFU/mL in the pharyngeal sample), while the remaining 49 newborns had sterile samples. Thus, the frequency of S. agalactiae vertical transmission with intrapartum antibiotic prophylaxis was 2% (n = 1). Of note, infection in the newborn caused no inflammation. Conclusion. Relatively low prevalence of vaginal carriage of S. agalactiae among pregnant women gives no sufficient grounds for the inclusion of such bacteriological examination into compulsory screening for infections in pregnant women in the Russian Federation. However, intrapartum antibiotic prophylaxis is an effective method to prevent streptococcal infection in newborns; it should be used in women at risk of GBS infections. Kew words: vaginal carriage of bacteria, intrapartum antibiotic prophylaxis, neonatal sepsis, Streptococcus agalactiae, intrauterine infection, screening for infections

The review analyses the results of using mesenchymal stem cells (MSCs) to restore fertility. Research works have shown that MSCs have the ability to differentiate into empryonic cells under specific induction conditions, and also when transplanted to gonadal tissue. Most studies were performed on MSCs obtained from bone marrow and the umbilical cord. Promising approaches related to the use of cell therapy have shown their high efficacy in preclinical studies: the infertility models in rats, mice and rabbits resulted in pregnancy after cell therapy. Research in this field is intensive: by now there is information about 11 preclinical and 12 clinical studies. The first results of clinical studies are positive. Clinical studies have been planned and started to determine the effect of MSCs transplantation on management of infertility, and their results, among others, will be decisive for introduction of cell therapy of infertility into clinical practice. The findings are promising, but further clinical research is needed to assess the efficacy and safety of MSCs transplantation for fertility restoration. Key words: infertility, gynaecology, treatment, MSCs, stem cells

The review considers current data on the diagnosis, treatment, and prevention of listeriosis during pregnancy. There are highlighted issues of epidemiology and transmission. The main methods of preventing listeriosis in pregnant women from the standpoint of evidence-based medicine are given.

Infectious diseases are still one of the main causes of perinatal losses worldwide. The consequences for the fetus and the newborn vary from asymptomatic infection to sepsis, malformations and the fetal death. Examination of pregnant women for the presence of infectious agents is an important part of the antenatal care program. The purpose of the work was to assess the structure of infectious screening in various medical institutions in Moscow, as well as the comparison of the recommended in Russia examinations with the main programs of antenatal monitoring in the world. Material and methods. The retrospective study was executed on the basis of four medical institutions: two state women’s clinics and two commercial clinics (the total number of patients - 902 people). The comparison was made with antenatal care programs of the antenatal observation in Centers for Disease Control and Prevention (CDC), 2015 (Centers for Disease Control and Prevention) in the United States of America, and the National Institute for Health and Care Excellence (NICE), 2017 (National Institute for Health and Medical Quality assistance), Great Britain. Results. Basic screening of pregnant women for infection in the Russian Federation includes 8 items (serological study of the blood for syphilis, HIV, hepatitis B and C, rubella, toxoplasmosis, microscopic examination of genital secretions on Neisseria gonorrhoeae and fungi of the genus Candida), which is significantly higher than in the USA and Great Britain (5 and 4 respectively). According to the results of our study, the volume of the compulsory examination of pregnant women is wider than abroad, due to serological examination of blood for the presence of antibodies to cytomegalovirus (CMV) and herpes simplex virus (HSV) of types 1 and 2, microbiological examination of genital secretions, molecular biological diagnosis (polymerase chain reaction - PCR, real-time PCR). Conclusion. Screening of pregnant women for infection in public and commercial clinics has a number of differences. The actual scope of the survey is higher than recommended by the state. The Russian list of tests in comparison with foreign analogs is much wider in terms of the number of nosologies and the frequency of the research. It is necessary to conduct multicenter epidemiological studies throughout the Russian Federation to create optimal regional programs for examining pregnant women for infection that meet the criteria for effective screening.

Herpes simplex virus of two types - HSV-1 and HSV-2, which can manifest as a primary and recurrent infection is the etiological factor of genital herpes. Herpes simplex virus is one of the most common sexually transmitted infections, in connection with which there is an increase in physical and psychological morbidity, which often remains an underestimated medical problem. With the vertical transmission of HSV during labor, diseases that are dangerous to the life and health in newborns can occur. Pregnant women with a primary infection of genital herpes belong to the high-risk group for the transmission of HSV to the newborn. Prophylaxis and prevention of vertical transmission of HSV are implemented in three directions: prevention of the recurrence of maternal genital HSV infection; prevention of transmission of the virus during pregnancy and childbirth; puerperal prophylaxis of the disease in a neonate infant born of a mother belonging to a high-risk group. This review focuses on such important aspects as laboratory diagnosis of HSV, antiviral therapy and prevention of viral infection during pregnancy, delivery and in the early neonatal period.