Objective. To study the efficacy and safety of combined (laser + electromyostimulation + pelvic floor muscle training) nonsurgical correction of pelvic organ prolapse (POP) recurrences in the late postoperative period in reproductive-aged, pre- and postmenopausal patients with different types of POP. Patients and methods. A comprehensive clinical examination, surgical treatment, and dynamic outpatient follow-up (at 1, 6, 12, 24, 36, and 48 months) of 523 patients with different types and severity of POP were performed. Disease recurrences were diagnosed in 69 (13.2%) women, 52 of whom underwent a combined non-surgical corrective therapy (laser + electromyostimulation + pelvic floor muscle training) with subsequent efficacy evaluation after 6 and 12 months. Results. Postoperative recurrences of POP were most often observed 12–36 months after surgical intervention using only own tissues (26.6%), less frequently – when synthetic implants were used (12.7%) and, extremely rarely, when titanium endoprostheses were inserted (1.6%). The positive effect of combined non-surgical correction in 32 (61.5%) women was expressed in a lower number and intensity of symptoms, improvement in the quality of life according to the PFDI-20 scale, optimization of gynecological examination data and quantitative parameters according to the POP-Q classification system. Conclusion. Combined non-surgical therapy (laser + electromyostimulation + pelvic floor muscle training) for postoperative recurrences of POP contributed to the optimization of clinical picture, dynamic improvement of the quantitative parameters of postoperative prolapse according to the POP-Q classification system, improvement of the quality of life of women, their social and sexual rehabilitation, which demonstrates the efficacy and safety of the implemented therapeutic program. Key words: postoperative recurrences of pelvic organ prolapse, combined non-surgical therapy, fractional CO2 laser, electromyostimulation, pelvic floor muscle training

Objective. To study the efficacy and safety of the original surgical instrument for trans-obturator insertion of ligatures and tapelike implants in patients with pelvic organ prolapse (POP) and stress urinary incontinence (SIU). Patients and methods. This study included 164 patients with POP and urethral hypermobility aged 34–79 years. The original threecomponent surgical instrument for trans-obturator insertion of ligatures and tape-like implants (Patent No. 217079, 2022) was used during surgery. Four developed surgical programs using titanium mesh implants and non-absorbable ligatures were implemented. Results. Patient questionnaire showed satisfaction with the results of surgical treatment in all cases, which had a positive effect on the quality of life, mood and contributed to an increase in social activity. Patients of reproductive age and in perimenopause reported an improved quality of sexual life. The recurrence of first-degree POP in the late postoperative period was diagnosed after 12–36 months in 5 patients (4.8%), but it did not require surgical re-intervention. Conclusion. Clinical approbation of the developed three-component instrument for trans-obturator insertion of ligatures and tape-like implants in patients with different degrees of POP and SIU confirmed its effectiveness and safety. The undoubted advantages of this instrument include convenient assembly, simple postoperative processing and sterilization, as well as the possibility of multiple use and, therefore, economic benefit, which, together with other useful parameters, makes this instrument universal for this type of surgery. Key words: gynecological surgical instrument, trans-obturator insertion of ligatures, tape-like implants

This article presents an original method of surgical treatment of complete uterine prolapse (a modification of the Neugebauer–Le Fort operation) in elderly and senile patients using titanium tape mesh implants, which contribute to strengthening and firm consolidation of the vaginal walls, elevation and stabilization of the postoperative position of pelvic organs (uterus, vaginal walls, bladder). Key words: complete uterine prolapse, elderly and senile age, modification of Neugebauer–Le Fort operation, titanium implants

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

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

Today, ART cycles using a donor egg cell are used more often, but this group of pregnancies has not been sufficiently studied in terms of detecting structural predictors of pregnancy complications caused by a special immunological relationship between the recipient mother and allogeneic blastocytes. A comprehensive clinical and morphological study of 89 allogeneic pregnancies was carried out. The morphological study was performed on placental sites biopsies taken at caesarean section (H & E, Orcein), for immunohistochemical analysis PanCK (AE1 / AE3), SMA (1A4), CD56 (123C3.D5), CD138 (B-A38), CD4 (SP35), CD25 (SP176), CD8 (SP16) were used as primary antibodies. A defect of the remodeling of the spiral arteries, including in subgroups without preeclampsia, the formation of perivascular foci of chronic inflammation were found (the accumulation of CD8 + T lymphocytes, CD56 + NK cells, CD138 + plasma cells, HLA-DR + dendritic cells). In subgroups with PE, significant changes were found for T lymphocytes (51.04 ± 2.3, 55.36 ± 11, 7 versus 37.12 ± 2.3), plasma cells (19.5 ± 3.2, 21.43 ± 8.4 versus 8.94 ± 1.2), Kruskal-Wallace test. Structural and immunohistochemical features of the allogenic placental bed may reflect the complexity of cytotrophoblast invasion and induction of maternal immunity with the formation of immune inflammation.

Введение. В структуре акушерских осложнений беременности, наступившей при применении вспомогательных репродуктивных технологий (ВРТ), существенная роль принадлежит комплексу факторов, включающих в себя нарушения гемореологии, дисрегуляцию параметров системы гемостаза, дисфункцию эндотелия со снижением его антитромботических свойств. Несмотря на накопленные знания, остаются открытыми вопросы, отражающие особенности гемореологических и микроциркуляторных факторов на разных сроках гестации в зависимости от способа наступления беременности с использованием ВРТ, что может иметь важное значение для разработки новых методов гемокоррекции и выборе тактики лечения при ведении пациенток в программах экстракорпорального оплодотворения (ЭКО). Цель исследования: изучить особенности реологических характеристик крови в разные гестационные периоды при беременности, наступившей в результате ЭКО. Материалы и методы. Проведено закрытое проспективное контролируемое когортное лонгитудинальное наблюдательное рандомизированное исследование. В исследование вошли 126 пациенток, которые были разделены на 4 группы в зависимости от способа наступления беременности. Для оценки реологических параметров крови в разные периоды гестации были выбраны 3 точки обследования: I триместр (7–8 нед); II триместр (19–21 нед); III триместр (30–34 нед). На выбранных сроках всем пациенткам проводили комплексное клинико-инструментальное и лабораторное обследование. Наряду со стандартным лабораторным обследованием в разные периоды гестации исследовали реологические характеристики эритроцитов, агрегационную способность тромбоцитов и уровень металлопротеазы ADAMTS-13. Результаты. Наибольшая частота гестационных осложнений (84,4%) наблюдалась в группе пациенток с донорскими ооцитами (группа I), а наименьшая (34,5%) ‑ в группе с самопроизвольно наступившей беременностью (группа IV). В группе I также определена наибольшая частота угрозы прерывания беременности в I (68,7%) и II (34,3%) триме­страх, тогда как угрожающие преждевременные роды (в 66,7% случаев) и преждевременная отслойка плаценты (в 23,3% случаев) чаще выявлялись в группе суррогатных матерей (группа II). Реологические характеристики эритроцитов в I триместре были существенно нарушены в группах I (с наибольшей выраженностью) и III (ВРТ с использованием собственных яйцеклеток) по сравнению с женщинами с самопроизвольно наступившей беременностью (группа IV) и суррогатных матерей (группа II). Такие реологические характеристики как амплитуда агрегации, индекс агрегации и скорость полной дезагрегации (γ-dis), отражающей плотность эритроцитарных агрегатов, были статистически значимо выше в группах пациенток I и III по сравнению с женщинами из групп II и IV. Значимые различия наблюдались и в деформируемости эритроцитов, которая была значительно снижена в группах I и III. В течение периода гестации в группах I и III на фоне изначально нарушенных реологических характеристик крови по мере увеличения срока беременности наблюдалась картина прогрессирования изменений как макро-, так и микрореологических параметров крови с наибольшей выраженностью этих нарушений у женщин с донорскими ооцитами (группа I). Гемореологический профиль периода гестации в группе II характеризовался следующим: на фоне нормальных показателей гемореологии в I триместре происходило резкое и значительное ухудшение всех макро- и микрореологических характеристик во II триместре (р = 0,000) для всех изученных показателей, кроме агрегации тромбоцитов с АДФ, адреналином и коллагеном. Заключение. При ведении беременных после программ ЭКО необходим индивидуальный подход к каждой пациентке в зависимости от способа наступления беременности с использованием ВРТ, тщательный анализ анамнестических данных, позволяющий определиться со степенью тромботического риска и необходимостью дополнительного обследования с учетом реологических характеристик крови. Выявленные изменения в макро- и микрореологических показателях крови у беременных после ЭКО обусловлены особенностями прегравидарной подготовки, преморбидным фоном, гормонотерапией, применяемой до гестационного периода и в процессе беременности, что способствует нарушению защитно-приспособительных механизмов на клеточном уровне. Перечисленные факторы приобретают особую значимость для ведения беременных в программах « Суррогатное материнство». Introduction. In the structure of obstetric complications of pregnancy that occurred with the use of assisted reproductive technologies (ART), a significant role belongs to a complex of factors, including impaired hemorheology, dysregulation of hemostatic parameters, and endothelial dysfunction with a decrease in its antithrombotic properties. Despite the accumulated knowledge, questions remain open that reflect the features of hemorheological and microcirculatory factors at different gestation periods, depending on the method of pregnancy following ART, which may be important for the development of new methods of hemocorrection and the choice of treatment tactics in the management of patients in IVF programs. Aim: to study rheological characteristics of blood during pregnancy after IVF at different gestational periods. Materials and Methods. We conducted a closed prospective controlled cohort longitudinal observational randomized study that included 126 patients who were divided into 4 groups depending on the way of getting pregnant. To assess blood rheological parameters at different periods of gestation we selected 3 examination points: I trimester (7–8 weeks); II trimester (19–21 weeks); III trimester (30–34 weeks). At the selected dates, all patients underwent a comprehensive clinical, instrumental and laboratory examination. Along with a standard laboratory examination, erythrocyte rheological characteristics, platelet aggregation capacity and the level of ADAMTS‑13 metalloprotease were studied at different periods of gestation. Results. The highest frequency of gestational complications (84.4%) was observed in the group of patients with donor oocytes (group I), and the lowest (34.5%) ‑ in the group with spontaneous pregnancy (group IV). The highest frequency of threatened abortion in the first (68.7%) and second (34.3%) trimesters was also determined in the group of patients with donor oocytes (group I), while threatened preterm labor (in 66.7% of cases) and placental abruption (in 23.3% of cases) were more often detected in the group of surrogate mothers (group II). Rheological erythrocyte characteristics in the first trimester of pregnancy were significantly impaired in groups I (with the greatest severity) and III compared with women with spontaneous pregnancy (group IV) and surrogate mothers (group II). Rheological characteristics such as aggregation amplitude, aggregation index and the rate of complete disaggregation (γ-dis), reflecting the density of erythrocyte aggregates, were statistically significantly higher in groups of patients I and III compared with the women from groups II and IV. Significant differences were also observed in the erythrocyte deformability that was significantly reduced in groups I and III. During the gestation period in groups I and III with initially impaired blood rheological characteristics, as the gestation period increased, a pattern of changes progression in both macro- and microrheological blood parameters was observed with the greatest severity of these disorders in women with donor oocytes (group I). The hemorheological profile of the gestation period in group II was characterized by the following: with normal hemorheological parameters in the first trimester, there was a sharp and significant deterioration of all macro- and microrheological characteristics in the second trimester (p = 0.000) for all studied parameters, except platelet aggregation with ADP, adrenaline and collagen. Conclusion. When managing preg­nant women after IVF programs, an individual approach to each patient is necessary, depending on the way of getting pregnant following the ART. Anamnestic data should be thoroughly analyzed to determine the degree of thrombotic risk and the need for additional examination, taking into account blood rheological parameters. The revealed changes in macro- and microrheological blood parameters in pregnant women after IVF are determined by the peculiarities of preparing for pregnancy, premorbid background, hormone therapy used before the gestational period and during pregnancy, which contributes to the impairment of protective and adaptive mechanisms at the cellular level. These factors are of particular importance for the management of pregnant women in the “Surrogacy” programs.

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 the results of surgical treatment of 3 patients aged between 35 and 42 years with stage II anterior vaginal wall prolapse who underwent a trocar-less transobturator correction of anterior prolapse with titanium mesh implants of individual sizes according to a newly developed technique using titanium fixators. The efficacy and safety of the new trocar-less surgical technique for correcting stage II anterior vaginal wall prolapse in patients of reproductive age using titanium implants and fixators were demonstrated. Conclusion. The trocar-less fixation of titanium implants of individual sizes using 4 titanium fixators, their combination with non-absorbable ligatures into a single functional unit, and multifocal fixation of implants contribute to the normalization of anatomic position of pelvic organs, relief of anterior prolapse symptoms, lower risk of injuries to obturator vessels and nerves, and lower incidence of mesh-related complications. Key words: pelvic organ prolapse, TiMesh-ligature colpopexy, trocar-less transobturator correction, titanium fixators

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

This review presents the analysis of literature which reveals the role of various factors contributing to the development of pelvic organ prolapse in women. The role and significance of factors leading to elevated intra-abdominal pressure, including obesity, are discussed. The effect of natural childbirth on the structure and function of pelvic floor is assessed. A current perspective on the influence of estrogen levels on the structure and properties of pelvic connective tissue in women is presented. The issue of metabolic and structural disorders of collagen in the development of pelvic organ prolapse as well as the role and significance of hereditary connective tissue disorders in the genesis of this disease are considered separately. The connection between pelvic surgeries such as hysterectomy and the subsequent development of pelvic organ prolapse is traced and analyzed. Particular attention is paid to the analysis of the effectiveness of surgical treatment for pelvic organ prolapse, also data on the use of mesh materials is provided, and the possibility of increasing the efficacy of surgical treatment by improving surgical techniques and using promising synthetic materials with stem cells is discussed. Key words: pelvic organ prolapse, hereditary connective tissue disorders, recurrence, pelvic floor, birth-related perineal trauma, risk factors for pelvic organ prolapse, surgical correction

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

Objective. To study the efficacy and to assess the safety of the use of titanium ribbon-like implants for surgical correction of various forms of apical prolapse. Patients and methods. 23 patients with apical prolapse (stage III–IV) aged 29 to 74 years were examined. Surgical correction of various forms of apical prolapse was performed using titanium ribbon-like mesh implants, which are more inert to the surrounding tissues than polypropylene scaffold systems. Dynamic outpatient observation of the patients was carried out after 3, 6, 12, 15 months after surgery. Results. The duration of surgery varied from 55 to 80 minutes, on average 74 ± 11.5 minutes. Intraoperative blood loss ranged from 50 to 150 mL (100 ± 35.7 mL). Of the early postoperative complications, only hematomas in the projection of the posterior vaginal wall of small sizes (up to 10 ml) – 2 (8.7%) were noted. Comparison of the questionnaire data from patients in the preand postoperative period showed an improvement in the quality of life of patients, an increase in their social and sexual activity. There was no significant displacement of the pelvic organs, and there were no mesh-associated complications. Conclusion. Laparoscopic bilateral subperitoneal hystero-, cervico-, colposuspension to the aponeurosis using titanium mesh ribbon-like implants improves the efficiency of surgical treatment of various forms and severity of apical prolapse. Key words: apical prolapse, hysterosuspension, titanium mesh implants

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

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

Objective. To study the effectiveness and safety of new surgical method for correcting the anterior vaginal wall prolapse using tissue-engineered constructs. Patients and methods. After preliminary experimental work on the creation and evaluation of the biocompatibility of tissueengineered constructs based on non-biodegradable (polypropylene and titanium endoprostheses) mesh implants with an autologous cellular component (rat and human dermal fibroblasts), 4 patients aged 44, 54, 70 and 75 years were examined. Inclusion criteria: anterior vaginal wall prolapse (stage II – III); consent to the installation of tissue-engineered construct. A fourstage surgical program providing for the correction of stage II-III anterior vaginal wall prolapse using tissue-engineered constructs of individual size was used. Results. In the early postoperative period, one patient was diagnosed with a small hematoma of the anterior vaginal wall. During the first month after surgery, one patient complained of gradual perineal pain, another patient – of frequent urination. Subsequently, these symptoms stopped. After 3, 6, 9, 12, 15 months after surgery, during the pelvic examination at rest, the Valsalva maneuver and transperineal ultrasound, no displacement of organs was detected, ultrasound clearly visualized a tissueengineered construct without displacement and deformation. Conclusion. We have developed an original method for correcting the prolapse of the anterior vaginal wall using tissueengineered constructs based on polypropylene and titanium with an autologous cellular component, which helps to optimize the results of surgical treatment, reduce the frequency of disease recurrence and the risk of developing mesh-related complications. Key words: pelvic organ prolapse, tissue-engineered constructs, surgical correction