This editorial summarizes the materials from the first issue of 2026, united by the idea of moving toward predictive and personalized medicine in obstetrics and gynecology. Original research presents digital models for risk stratification of preterm birth and preeclampsia, neural network algorithms for selecting therapy for ovulation disorders, immunological and coagulation markers of placental complications, as well as data on long-term cardiometabolic risks after preeclampsia and factors preserving ovarian reserve. Review publications highlight current understanding of thrombosis pathogenesis in paroxysmal nocturnal hemoglobinuria, the role of natriuretic peptide in obstetrics and neonatology, immunocoagulation mechanisms of amniotic fluid embolism, the molecular basis of HPV-associated neoplasia, and fertility restoration strategies in women of late reproductive age. A clinical case of antenatal diagnosis of placenta accreta using modern ultrasound criteria is presented. The issue also includes retraction note due to identified unfair plagiarism, underscoring the editorial board's commitment to publication ethics. Taken together, the materials in this issue reflect contemporary developments in the specialty – risk stratification, personalized therapy, and the expansion of preventive care in obstetrics and gynecology.

Introduction. Preterm birth (PTB) remains one of the most serious complications of pregnancy, being the leading cause of neonatal mortality and contributing to long-term disability along with chronic morbidity in newborns, as well as imposing substantial socioeconomic costs. Despite preventive efforts, the global PTB rate has remained largely unchanged comprising 5–18 %, underscoring a need for developing more effective prediction tools to enable timely prevention.

Aim: using an independent sample to develop and validate a PTB risk-assessment tool based on machine learning (ML) and routinely collected clinical data retrieved from electronic health records (EHRs) of pregnant patients.

Materials and Methods. We analyzed a dataset of 10,000 de-identified EHRs entries containing 54 variables, including historical, clinical, laboratory, and instrumental (diagnostic/imaging) data. The predictive system comprised two interconnected ML components: (1) an NLP model based on RuBERT (а pre-trained ML model for processing Russian texts) for extracting PTB-relevant features from unstructured Russian-language clinical text, and (2) a downstream predictive ML model, for which 14 algorithms were benchmarked.

Results. The NLP model demonstrated high performance with a median sensitivity = 0.998, F1-score = 0.976, and AUC-ROC = 0.974. Among the ML algorithms, the algorithm based on gradient boosting – CatBoost Classifier (Categorical Boosting Classifier) achieved the best risk-prediction results: accuracy = 0.81, sensitivity (recall) = 0.87, precision = 0.76, F1-score = 0.81, and AUC-ROC = 0.82.

Conclusion. The developed model showed performance comparable to that of international counterparts, and validation confirmed its robustness to previously unseen data, indicating strong potential for use in routine clinical practice. This study represents the first step toward an integrated PTB risk-assessment solution combining NLP and ML. Future work will include incorporation of additional predictors (e.g., biochemical markers) and multicenter validation studies.

Introduction. Approximately 20 % of reproductive age women are obese, and more than half of them experience menstrual irregularities, anovulation, and infertility.

Aim: to determine predictors of ovulation restoration and to develop a model for individual treatment selection in patients with obesity and oligo-/amenorrhea based on neural network technology.

Materials and Methods. The prospective randomized controlled study included 80 women – patients with obesity and oligo-/amenorrhea, divided into 2 groups, who received the following therapy for 6 months: 40 patients (group I) – a combination of myoinositol, D-chiroinositol, folic acid and manganese, the other 40 patients (group II) – metformin. After treatment, patients from both groups were divided into two clusters based on the "anovulation/ovulation" criterion. Anthropometric parameters were determined, pelvic organs ultrasound was performed, laboratory tests (indicators of carbohydrate and fat metabolism, amino acids and peptides, hormonal status, blood cytokine levels, inflammation markers, and blood micronutrient composition) were performed. To create a model for predicting ovulation restoration, a multilayer perceptron procedure was used. The diagnostic value of the prognostic model was determined using ROC analysis.

Results. The average age of the patients was 27.9 ± 3.8 years, with the average body mass index (BMI) 33,4 [31.2; 34.0] kg/m2. The following parameters were identified as significant anovulation predictors using neural network analysis: waist-to-hip ratio (WHR), menstrual cycle duration, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), C-reactive protein, leptin, follicle-stimulating hormone, 25-hydroxycalciferol (vitamin D), and tumour necrosis factor alpha. Because these parameters reflect the metabolic profile in patients, interventions to restore ovulation should primarily be aimed at correcting it. The developed model for predicting the onset of ovulation has a sensitivity of 100 %, specificity of 80 %, accuracy of 93.8 %; the area under the ROC curve is 0.985 (p < 0.001), which allows to consider it sufficiently informative for specific drug selection. For practical purposes, an online calculator for individual drug selection has been developed (accuracy – 91.7 %).

Conclusion. An integrated approach based on neural network analysis of study parameters available for wide clinical practice is promising for predicting the onset of ovulation while using a specific drug due to its high information content.

Introduction. Chronic placental insufficiency (CPI) is one of the leading causes of fetal growth restriction (FGR), perinatal loss, and complicated pregnancy. Currently, no validated methods for predicting CPI during pregnancy planning are available, which complicates high-risk patient stratification early and enabling timely prevention.

Aim: to develop a mathematical model for predicting CPI risk in women with a complicated obstetric history at the pre-pregnancy preparation stage.

Materials and Methods. A retrospective clinical study assessing 462 patients with a complicated obstetric history was conducted. The outcomes of previous pregnancies, concomitant extragenital diseases, circulation of criterial (anti-β2glycoprotein and anti-cardiolipin antibodies, lupus anticoagulant) and non-criterial (anti-annexin 5, anti-phosphatidylserine, anti-phosphatidylinositol, anti-prothrombin, anti-human chorionic gonadotropin) antiphospholipid antibodies (APA), indicators of lymphocyte subpopulation composition, coagulation profile, and genetic thrombophilia were evaluated. Enzyme-linked immunosorbent assay, flow cytometry, ultrasound, and histological diagnostics were used. Binary logistic regression was applied to construct a prognostic model, and the diagnostic significance of the indicators was assessed using ROC curves.

Results. Detected APA high titers and/or lupus anticoagulant were associated with significantly elevated CPI incidence (63.1% vs. 4.6%; p < 0.001) and FGR (43.4% vs. 4.6%; p < 0.001). Immunological imbalance (increased percentage of B-lymphocytes and NK cells) increased CPI risk by 1.3–5.5 times. The constructed prediction model, which included indicators of immunological activity and comorbidity, demonstrated high accuracy: AUC = 0.89, sensitivity 85.7%, specificity 85.7%.

Conclusion. The developed mathematical model allows for highly accurate prediction of CPI risk developing in women with a complicated obstetric history even before pregnancy, which opens up avenues for personalized selection of preventive measures, including immunomodulatory therapy and dynamic monitoring, and contributes to lowering frequency of perinatal complications.

Introduction. Preeclampsia (PE) remains one of the leading causes for maternal and perinatal morbidity and mortality. Placental insufficiency associated with impaired trophoblast invasion, hypoperfusion, and inflammatory endothelial activation is considered a key link to developing PE. In recent years, an interest to assessing a role of the complement system, an important innate immunity component involved in maintaining maternal-fetal tolerance has been growing. An imbalance in complement system activation may lead to damage to the trophoblast, altered placental blood flow, and development of pregnancy complications, including early-onset and late-onset PE as well as fetal growth restriction (FGR). Studying the activity of individual complement components (C1q, C3a, MAC) in PE allows to clarify the immune mechanisms underlying placental dysfunction and identify potential diagnostic and prognostic markers. However, the contribution of individual complement arms in severe PE remains poorly understood, thereby justifying clinically significance for investigating their levels and activity.

Aim: to determine diagnostic and prognostic value for complement system components (C1q, C3a and MAC) in pregnant women with severe PE, by taking into consideration differences between early-onset and late-onset disease forms to be compared with healthy pregnant women in control group.

Materials and Methods. A single-center observational study with cross-sectional comparative analysis at the inclusion stage and subsequent collection of perinatal outcomes was conducted among pregnant women with severe PE and healthy pregnant women with physiological pregnancy. There were enrolled 120 pregnant women, matched for age and gestational age, divided into 4 groups: with early-onset PE, developing at ≤ 34 weeks of pregnancy (n = 56); with late-onset PE, developing after 34 weeks (n = 32); control group 1 – healthy pregnant women with physiological pregnancy at ≤ 34 weeks (n = 17); control group 2 – healthy pregnant women with physiological pregnancy at > 34 weeks (n = 15). The analysis of clinical and laboratory parameters was carried out, which included demographic data, obstetric history, obstetric complications, concomitant diseases, hemostasis parameters, general clinical laboratory parameters, perinatal data, immunological parameters of the complement system – levels of C1q, C3a and membrane attack complex (MAC, C5b–C9). The levels of complement system components were quantitated by enzyme-linked immunoassay.

Results. In severe PE, complement system hyperactivation occurs, manifested by increased C1q, C3a and MAC levels. Complement component C1q concentrations ≥ 250 ng/ml were associated with developing FGR risk (p < 0.008). The C3a component was elevated in FGR and impaired uteroplacental blood flow, as well as in early-onset and late-onset PE. C3a values ≥ 615 ng/ml had moderate predictive ability for FGR (p = 0.004) and for blood flow disorders (p = 0.048). The terminal component of the complement system, MAC (C5b–C9) was significantly elevated in late-onset РЕ and FGR, indicating pathway activation and damage to trophoblast cells. A MAC cut-off value of ≥ 2717 mAU/ml predicted FGR development with sensitivity of 61.0 % and specificity of 82.0 % (p = 0.009).

Conclusion. The changes identified in our study confirm that excessive complement activation and MAC formation play a significant role in developing placental insufficiency, PE, and FGR, and that quantitating C1q, C3a, and MAC levels can be used as an additional biomarker tool for predicting pregnancy complications.

Introduction. Pregnancy and labor complicated by adverse conditions pose a threat not only to offspring but also to maternal health in later life. Preeclampsia (PE) has a long-term impact on maternal health, increasing the risk of subsequent somatic diseases. However, the number of studies investigating PE effects on maternal long-term somatic health are limited that determines the relevance of the present study.

Aim: to assess the somatic health of women with/without PE during pregnancy and labor who delivered female infants.

Materials and Methods. A retrospective case–control study was performed. A total of 1,302 medical records of women who delivered female infants in 2006–2007 were analyzed. The study sample included 198 patients meeting the inclusion criteria: spontaneous singleton gestation, term delivery of a live female infant in 2006–2007, and a medical record indicating either the presence or absence of PE. Based on obstetric history, the subjects were allocated to two groups: main group (n = 94), which included women diagnosed with PE during pregnancy and/or labor, and control group (n = 104), composed of women with uncomplicated pregnancies and labors. Archival obstetric records were analyzed, and somatic health was assessed based on medical documentation provided by the patients, including anthropometric measurements.

Results. The assessment of somatic health and anthropometric parameters revealed statistically significant differences between the study groups. Women with PE history showed a significantly higher prevalence of сardiovascular diseases, overweight, and obesity as well as lower parity compared with women whose pregnancies proceeded physiologically (p < 0.001). The probability of having hypertension was 3.297 times higher in PE group, with statistically significant difference (95 % confidence interval (CI) = 1.801–6.037; р < 0,001). No significant differences in the phenotypes of hypertension were identified. Notably, women with PE history were characterized by a significantly higher mean age of labor (p = 0.028), incidence of malignant neoplasms (p = 0.023) and a more frequently burdened family history of hypertension (p = 0.002). In addition, inter-group differences were considered statistically significant at p < 0.05.

Conclusion. Pregnancy complicated by PE increases the risk of subsequent cardiovascular diseases in general and hypertension in particular, overweight, and obesity in this group of patients. The data highlight the necessity for preconception prevention of hypertensive disorders, careful assessment of PE risk factors including family history and a personalized approach to the management of this patient cohort. These results underscore the importance of developing further strategies for PE prevention and early diagnosis, as well as implementing multidisciplinary long-term follow-up of women with PE history.

Aim: to determine the optimal tactics for managing patients with deep infiltrating endometriosis.

Materials and Methods. A prospective cohort clinical trial was conducted with 69 patients examined following surgical treatment for extensive infiltrating endometriosis and 3-month-long anti-relapse therapy with gonadotropin-releasing hormone agonists. Reproductive potential was assessed based on quantitating anti-Müllerian hormone (AMH) before and 6 months post-surgery, recording cases with/without onset of spontaneous pregnancy within 1 year.

Results. While comparatively analyzing AMH level in preand postoperative period revealed its decline in 51.8 % by average 0.152 ng/ml; the smallest reduction was found in women aged 28.5 to 33.5 years, regardless of the extent of surgical treatment. Pregnancy occurred in 10 of 43 planning women (average age 36,0 [32,0–42,5] years): 7 patients underwent ovarian interventions, 3 – surgical treatment for endometriosis of other localizations.

Conclusion. The data obtained evidence that subject’s age plays a decisive role in maintaining reproductive potential and a need for a differentiated approach in developing individual tactics for management and treatment of patients with deep infiltrating endometriosis, taking into account age, localization of endometriosis and reproductive plans.

Aim: to study the features of lichen sclerosus (LS) clinically manifested in various age group girls.

Materials and Methods. A prospective observational study with 202 girls aged 0 to 18 years having verified LS clinical and histological diagnosis of LS was conducted. The age of LS onset was examined, determining the time from the appearance of the first symptoms to diagnosis was by analyzing most characteristic disease symptoms such as itching, changes in skin structure and color, the presence of cracks, constipation, dysuria, and lesion area related to childhood age period.

Results. It was found that 30 % LS girls noted the first disease symptoms at the age of 5–6 years (n = 67; 33.1 %). Among patients with vulvar LS, middle childhood (aged 3–5 years) girls predominated (n = 66, 32.7 %). Girls in early childhood (up to 2 years) and puberty period (13–17 years) were in minority comprising as few as 7 (3.5 %) and 19 (9.4 %) cases, respectively. The average LS duration before being properly diagnosed was 2.61 ± 0.13 years. In 27.7 % (n = 56) girls, the disease was asymptomatic, more often in younger patients aged 3–5 years (n = 10). Complaints of itching in the vulva, perineum and perianal area were reported in 58.9 % (n = 119) cases, but only five (2.48 %) girls had itching as a single complaint. In most cases, changes affected all 5 zones – the clitoris, labia minora, the inner surface of the labia majora, perineum and perianal area. A "figure eight"-like LS lesions of the genital tract were observed in 75.2 % (n = 152) girls, more often found in prepubertal (79.8 %; n = 79) and pubertal (82.9 %; n = 29) age.

Conclusion. LS incidence peaks during the transition from middle to late childhood. A more than nine-year observation was shown to shorten average duration of the disease before its diagnosis from 6 to 1.6 years. Analyzing pattern of complaints related to the age of girls allowed to conclude that LS exhibits no specific complaints, except for changes in vulvar skin structure and color, which are noticed only by 5 % patients. Itching in the vast majority of cases (n = 119; 58.9 %) is a consequence of arising complications such as cracks, ecchymosis and erosions.

Introduction. Preeclampsia (PE) remains one of the leading causes of maternal and perinatal morbidity and mortality, while most cases are still diagnosed at the stage of clinically overt disease. Complex prediction algorithms incorporating biochemical biomarkers and Doppler velocimetry demonstrate high accuracy but are poorly suited for large-scale screening in resource-limited settings.

Aim: to develop, internally and externally validate mathematical models for predicting PE risk at gestational age of ≤ 16 weeks based on routine electronic health records (EНRs) data and machine learning methods.

Materials and Methods. A retrospective cohort study was conducted using de-identified EНRs of pregnant women from eight regions of the Russian Federation spanning 2010–2025. The analytical dataset included 19,955 visits at gestational age ≤ 16 weeks. The composite outcome comprised PE, eclampsia and HELLP syndrome identified by ICD-10 codes. A broad spectrum of clinical, medical history and anthropometric variables was evaluated as potential predictors. Models (logistic regression, gradient boosting, Random Forest, Extra Trees) were trained with adjustment for class imbalance; feature selection was based on SHAP values (SHapley Additive exPlanations indices). Internal performance was assessed on a held-out test set, and independent external validation was performed on a subsample from healthcare facilities of the Republic of Karelia (n = 918).

Results. The final Extra Trees model including 35 clinically interpretable predictors achieved a ROC-AUC (Receiver Operating Characteristic curve; Area Under Curve) of 0.871 (95 % confidence interval (CI) = 0.811–0.923) and 0.862 (95 % CI = 0.833– 0.892) in internal and external validation set, respectively. At a probability threshold of 0.04, sensitivity in the external cohort was 0.886, specificity was 0.631, and negative predictive value (NPV) exceeded 0.99. Probability calibration was moderate (mean absolute calibration error was 0.245–24.5 percentage points). The strongest contributors to PE risk were chronic hypertension, history of PE, blood pressure parameters, antiphospholipid syndrome and diabetes mellitus.

Conclusion. The Extra Trees model developed on routinely collected EНRs data demonstrates acceptable discriminative ability, high sensitivity and very high NPV and may be considered as a screening tool for early PE risk stratification, provided local calibration assessment and further clinical evaluation.

Aim: to evaluate the clinical significance of hemostasis control during anticoagulant therapy in patients with post-in vitro fertilization (IVF) pregnancy and burdened obstetric history (ВОН).

Materials and Methods. A prospective observational clinical comparative study was conducted. The main group consisted of 64 women with ВОН, with singleton (subgroup I1, n = 38) and multiple (dichoric diamniotic twins) pregnancies (subgroup I2, n = 26) following IVF, used low molecular weight heparins (LMWH). Control group: 35 pregnant women with singleton pregnancies (subgroup C1) and 35 with twins (subgroup C2) following IVF. Hemostasis was assessed by measuring APTT (activated partial thromboplastin time), PT (prothrombin time), TT (thrombin time), fibrinogen, antithrombin, protein C, protein S, protein C function (test РrоС Global); D-dimer; platelet aggregation with ristocetin, ADP (adenosine-5-diphosphate) and collagen, anti-Xa activity, thromboelastography, antiphospholipid antibodies and genetic thrombophilia.

Results. Post-IVF pregnancy in patients with ВОН and the risk of thrombosis during controlled anticoagulant prophylaxis was accompanied by lowered incidence of complications compared with control group: impaired uteroplacental blood flow was observed in 7.8 % vs. 24.3 % (p < 0.05), fetal growth restriction – in 3.1 % vs. 12.9 % (p < 0.05), preeclampsia – in 6.3 % vs. 20.0 % (p < 0.05), threat of pregnancy termination in the first trimester – in 14.1 % vs. 28.6 % (p < 0.05), in the second trimester – in 7.8 % vs. 21.4 % (p < 0.05). The controlled LMWH use was associated with favorable pregnancy course and outcome. Assessing dynamics of hemostasis parameters during anticoagulant and antiplatelet therapy allowed to substantiate the need to increase LMWH dose during pregnancy progression, to assess its adequacy and safety.

Conclusion. The increased hypercoagulation upon pregnancy progression requires monitoring the adequacy of anticoagulation therapy in risk groups, especially in post-IVF multiple pregnancies.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired clonal hematopoiesis disorder caused by a somatic mutation in the PIGA (phosphatidylinositol glycan, class A) gene, resulting in deficiency of glycosylphosphatidylinositol (GPI)anchored complement regulatory proteins on blood cell surface. Dysregulation of the complement system leads to chronic intravascular hemolysis, anemia, endothelial dysfunction as well as development of prominent acquired thrombophilic state, clinically manifested by venous thromboembolism, frequently involving atypical vascular sites. Thrombotic complications represent the leading cause of adverse outcomes and mortality in patients with PNH. This review summarizes current evidence on PNH etiology, molecular genetics and pathophysiological mechanisms including complement dysregulation, nitric oxide depletion, intraand extravascular hemolysis, and the multifactorial pathogenesis of thrombosis. The clinicopathogenetic relationship between PNH, aplastic anemia, and myelodysplastic syndromes is discussed in the context of immune-mediated bone marrow failure. Special emphasis is put on PNH course in women of reproductive age. Physiological changes associated with pregnancy and the postpartum period, including complement activation and hypercoagulability, are shown to be associated with increased risk of hemolytic crises and thromboembolic complications in women with PNH, thereby defining the disease as a condition of extremely high obstetric risk. Contemporary principles for multidisciplinary management aimed at improving maternal and perinatal outcomes are reviewed.

This article presents general information on demographic processes in Russia and the relevance of using highly effective contraception methods particularly combined oral contraceptives (COCs), to prevent artificial abortions. The importance of high-quality counseling for prescribing estrogen-progestogen medications is emphasized. Clinical situations for the preferential choice of a three-phase combined ethinyl estradioland desogestrel-based contraceptive are described.

Brain natriuretic peptide (BNP) is a well-known marker in cardiology used for the diagnosis, prognostic assessment, and treatment selection in patients with congestive heart failure. In obstetrics, BNP has been studied in pregnant women with gestational hypertension, preeclampsia, fetal distress, cardiovascular diseases, and gestational diabetes mellitus. Elevated BNP levels have been reported in the umbilical blood of newborns with intrauterine growth restriction. Recent studies indicate that BNP is also useful in assessing newborns condition and predicting neonatal adaptation. In children, BNP serves as an indicator of heart diseases and can be used to monitor treatment response. The diagnostic role of plasma BNP in newborns admitted to intensive care units has shown promise as an auxiliary marker in diagnosing congenital heart defects, bronchopulmonary dysplasia, patent ductus arteriosus, and persistent pulmonary hypertension, as well as in acute heart failure. Most studies evaluating cardiac dysfunction and myocardial injury in newborns rely on echocardiography; however, myocardial function can also be assessed using plasma biomarkers. BNP has proven to be an invaluable complement to echocardiography in evaluating ventricular function in infants and children.

Amniotic fluid embolism (AFE) is a rare, life-threatening obstetric complication, known in modern terminology as anaphylactoid syndrome of pregnancy (ASP). ASP is an acute reaction triggered by the penetration of amniotic fluid (containing fetal cells, meconium, tissue factor, etc.) into the maternal circulatory system. This leads to a cascade of pathological reactions comprising the classic triad of fetal hypoxia: acute hypoxia (dyspnea, cyanosis), circulatory collapse (shock, cardiac arrest), and coagulopathy (bleeding). Fetal hypoxia is a diagnosis of exclusion; its treatment is aimed at combating the three main threats: respiratory failure, hemodynamic collapse, and coagulopathy. The prognosis is extremely grave, with maternal mortality reaching 80–90 %. Perinatal mortality and morbidity are also very high due to acute fetal hypoxia. ASP remains one of the most dangerous and poorly predicted causes of maternal mortality. A high level of physician vigilance, awareness of early symptoms, and immediate initiation of comprehensive resuscitation and intensive care aimed at maintaining oxygenation, hemodynamics, and correcting coagulopathy are crucial. The modern therapeutic approach to the syndrome as an anaphylactoid reaction justifies the use of high glucocorticosteroid doses.

Human papillomavirus (HPV) is the main risk factor for developing cervical cancer (CC). About 70–75 % of all invasive CC cases worldwide are associated with HPV 16 and 18 genotypes, 20–25 % cases being related to HPV 31, 33, 35, 45, 52, and 58 genotypes. Currently, there are more than 100 tests for HPV diagnostics, but up to now, it has been difficult to establish and evaluate sensitivity of cytological examination for detecting pre-invasive and invasive cervical squamous and glandular lesions. The use of biomarkers for a more objective diagnostics of squamous intraepithelial lesions (SIL) was investigated in numerous studies. The most widely used biomarker is the p16INK4a (p16) antibody that flags E7-induced high-risk HPV-caused cell proliferation. The diagnosis of SIL upon cervical biopsy is also highly variable convincingly supported by the documented evidence. The intermediate category, cervical intraepithelial neoplasia grade 2 (CIN2), provides the least reproducible results. The use of immunohistochemistry p16, alone or in combination with the proliferation marker Ki-67, increases the effectiveness of differentiation between SIL and its benign imitators. Thus, a high degree of variability still is observed between the data of cervical cytology and biopsy due to both sampling errors and the expertise of medical works involved in data interpretation. Atypical squamous cells of undetermined significance (ASC-US) represent the primary source of such variability.

Aim: to systematize current data on diagnostic potential and therapeutic approaches to restore fertility in women of advanced reproductive age with diminished ovarian reserve, as well as to identify promising directions for further research.

Materials and Methods. The review includes scientific publications indexed in PubMed/MEDLINE, Scopus, Web of Science, Google Scholar spanning from January 2020 to January 2025 inclusive, according to the indexing status at the time of the literature search. Article selection was performed in accordance with the PRISMA international guidelines. At the initial search stage, 397 publications were identified in PubMed/MEDLINE, 96 in Scopus, 121 in Web of Science, and 28 in Google Scholar. Duplicate and non–full-text records were excluded. After the selection procedure, 60 publications were included in the final review, comprising randomized clinical trials, meta-analyses, systematic reviews.

Results. Literature analysis demonstrated that the assessment of anti-Müllerian hormone levels and the antral follicle count remain the most reliable predictors of ovarian reserve and treatment outcomes. Individualized protocols for controlled ovarian stimulation improve the rate of mature oocyte retrieval; however, their efficacy is limited by age-related decline in oocyte quality. Experimental approaches such as platelet-rich plasma (PRP) therapy, stem cell application, and mitochondrial support show promising results in pilot studies but require further standardization and evaluation of long-term safety. The use of donor oocytes remains the most effective strategy in cases of severe ovarian reserve depletion.

Conclusion. Despite advances in elucidating the pathogenesis of ovarian aging, optimizing fertility restoration in women of advanced reproductive age with diminished ovarian reserve remains a multifactorial challenge. The most promising directions include the individualized selection of stimulation protocols, integration of supportive and experimental methods, as well as development of molecular and genetic biomarkers for personalized therapy.

Introduction. The rising global incidence of cesarean deliveries has led to elevated abnormal placentation, particularly placenta accreta spectrum (PAS) disorders. These conditions represent serious obstetric complications with high risks for both maternal and fetal morbidity and mortality.

Аim: to analyze a clinical case of placenta increta with deep invasion, highlighting the diagnostic value of advanced ultrasonographic techniques.

Case presentation. A 29-year-old pregnant woman with a history of three cesarean sections (2014, 2017, and 2025) and prominent somatic comorbidities (chronic pyelonephritis and urolithiasis) underwent routine antenatal ultrasound screenings at 8, 12, 20, 23, and 28⁺⁶ weeks of gestation. Standard transvaginal and transabdominal sonographic techniques were used. After sonographic suspicion of placenta increta, magnetic resonance imaging (MRI) was performed for verification. Final diagnosis was confirmed intraoperatively and through histopathological analysis. Ultrasound revealed signs consistent with PAS type 2 (placenta increta): marked thinning of the myometrium, dilated lacunae, retroplacental hypervascularization, and placental bulging. At 28⁺⁶ weeks, transvaginal sonography detected further invasion into the cervical canal (PAS 3a). Color Doppler imaging revealed vascular "rail signs," indicating deep invasion. MRI confirmed complete placenta previa with abnormal tissue growth into the uterine scar and myometrial layers. This case demonstrates the effectiveness of modern ultrasonography and Doppler imaging in the early identification and classification of PAS disorders. Although previous publications emphasized limitations in determining invasion depth via ultrasound, this report highlights its diagnostic reliability, especially when complemented by MRI. Early diagnosis is essential for surgical planning and improving perinatal outcomes.

Conclusion. Ultrasound primarily combined with color Doppler imaging, provides a reliable and non-invasive means for diagnosing PAS disorders. In this case, the identification of specific Doppler features – particularly the "rail sign" representing vascular bridging between the myometrium and serosa – proved critical for diagnosing placenta increta. These findings highlight a potential for advanced Doppler markers in improving antenatal detection and surgical planning. Integrating such diagnostic techniques into routine care can markedly improve maternal and fetal outcomes in high-risk pregnancies.

The following article is retracted: Policheva A.A., Oganesyan E.A., Yarushkina I.S., Martynenko A.S., Kormukhina E.E., Taimova Ch.O., Mustafina A.R., Kim V.V., Valitova A.A., Suleimanov N.R., Gaibaryan K.A., Radzhabov M.E., Baimukhambetova A.E., Razumova A.E. The role of sphingolipid metabolism in female reproductive health disorders. Akusherstvo, Ginekologia i Reprodukcia = Obstetrics, Gynecology and Reproduction. 2025;[published online]. (In Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.691. An unattributed translation (i.e. plagiarism) has led to the retraction.