Introduction. External genital endometriosis (EGE) is a chronic, relapsing disease that affects various aspects of sexual function, the quality of sexual and interpersonal relationships, physical and psycho-emotional health and leads to social maladjustment and anxiety-depressive disorders, resulting in progressively decreased quality of life (QoL).

Aim: to analyze an impact of sexual disorders on QoL of women with painful and painless EGEs.

Materials and Methods. A prospective comparative randomized interventional study involved 160 patients (110 and 50 women with painful and painless EGE, respectively) of reproductive age, with laparoscopically and morphologically verified diagnosis according to the revised American Fertility Society scoring system (R-AFS, 1996). Pain syndrome and sexual dysfunction were assessed using specialized questionnaires: visual analogue scale (VAS), PainDETECT, and Female Sexual Function Index (FSFI). After surgical treatment, 8 patients refused to participate in the study (6 with painful EGE and 2 with painless EGE). Thus, only 152 women passed all stages of the study. The patients were divided into 4 groups depending on the presence and/or absence of pain syndrome and the tactics of the rehabilitation period ("active" or "passive"): group IA consisted of 49 (47.1 %) women with pain and "active" rehabilitation; group IБ – 55 (52.9 %) women with pain syndrome and "passive" rehabilitation tactics; group IIA – 23 (47.9 %) patients without pain syndrome with "active" rehabilitation; group IIБ – 25 (52.1 %) patients without pain syndrome with "passive" rehabilitation tactics.

Results. Women with painful vs. painless EGE were found to have a more severe course of the disease and a markedly decreased quality of sexual life. It was observed that patients with "active" rehabilitation tactics (groups IA and IIA) had intensity of the pain syndrome and the neuropathic pain component significantly decreased, improved parameters of the quality of sexual life, sexual desire and sexual excitability compared to patients with "passive" rehabilitation tactics applied with the measures within the framework of the National Clinical Guidelines (groups IБ and IIБ).

Conclusion. A significantly decreased quality of sexual life of EGE patients indicates a need for assessing and correcting sexual disorders as well as introducing early onset of rehabilitation measures by using a multidisciplinary approach.

Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women.

Aim: to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy.

Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020–2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1 – 57 patients with asymptomatic and mild form of verified COVID-19; Group 2 – 50 patients with COVID-19 of moderate and severe course; Group 3 – 52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19.

Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries – 54 (94.7 %) and 38 (76.0 %) (χ2 = 7.76) respectively, as well as a significantly lower number of premature births – 3 (5.3 %) and 12 (24.0 %) (χ2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births – 33 (57.8 %) and 42 (80.8 %) (χ2 = 6.63) respectively, but a greater rate of caesarean section – 24 (42.0 %) and 10 (19.2 %) (χ2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) – 16 (28.1 %) and 2 (6.3 %) (χ2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia – 5 (8.8%) and 42 (84.0%) (χ2 = 61.2; p < 0.001) respectively, increased aspartate aminotransferase – 4 (7.0 %) and 38 (76.0 %) (χ2 = 53.15; p < 0.001), lactate dehydrogenase (LDH) – 0 (0.0 %) and 12 (24.0 %) (χ2 = 15.41; p < 0.001), C-reactive protein (CRP) – 6 (10.5 %) and 49 (98.0 %) (χ2 = 81.58; p < 0.001), creatinine reduction – 0 (0.0 %) and 11 (22.0 %) (χ2 = 13.98; p < 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase; a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level.

Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity.

Introduction. Postpartum complications hold one of the leading places in the pattern of gynecological diseases.

Aim: to study the clinical and laboratory features of developing postpartum inflammatory complications.

Materials and Methods. There were examined 150 puerperas at the Scientific Research Institute of Obstetrics and Gynecology (Baku, Azerbaijan) in the years from 2019 to 2021, who were subdivided into 2 groups: the main group – puerperas with developed postpartum complications (n = 100), aged 29.9 ± 0.64 years and the control group – puerperas with a physiological course of postpartum period (n = 50), aged 30.3 ± 0.86 years (p = 0.679). We studied the general and obstetric-gynecological anamnesis. The following parameters of the peripheral blood samples were analyzed: total leukocyte count, absolute and relative lymphocyte level, erythrocyte and platelet counts, the hemoglobin concentration, erythrocyte sedimentation rate, and quantity of serum interleukin-6 (IL-6).

Results. It was found that puerperas of the main vs. control group had increased level of serum pro-inflammatory cytokine IL-6 (24.26 ± 0.48 pg/ml vs. 10.36 ± 0.62 pg/ml; p = 0.001) considered as an additional risk factor for developing postpartum complications. Regarding cellular immune parameters, they were shown to have decreased CD4+/CD8+ ratio due to blood elevated CD8+ lymphocyte count and decreased level of CD4+ T-cells. The development of postpartum inflammatory complications in the main group was associated with menstrual disorders in 81.0 ± 3.92 % of cases, first births – in 60.0 ± 4.90 %, threatened miscarriage – in 19.0 ± 3.92 % and gestational toxicosis – in 52.0 ± 5.00 % of the total cases. Some risk factors were associated with diseases of the genitourinary system (main vs. control groups: chronic pyelonephritis 24.0 ± 4.27 % and 10.0 ± 4.24 %, respectively; p = 0.048) and respiratory organs, most often represented by chronic tonsillitis and sinusitis (main vs. control groups: 20.0 ± 4.00 % vs. 4.0 ± 2.77 %, respectively; p = 0.007).

Conclusion. The course of the postpartum period in primiparas as well as women with burdened history of obstetric-gynecological and extragenital pathology is characterized by a high proportion of inflammatory complications. Biochemical studies assessing peripheral blood T-lymphocyte count and serum level of the pro-inflammatory cytokine IL-6 can be used as an additional diagnostic method to identify and assess modality and severity of early puerperal complications.

Aim: to determine a role of specific parameters of coagulation hemostasis for development of severe early-onset preeclampsia (еPE) in low-risk patients.

Materials and Methods. A single-center prospective study included 40 patients with a physiological course of pregnancy and term delivery (control group) as well as 41 pregnant women with developed severe еPE (study group). Patients at the gestational age of 19–21 and 27–28 weeks in the comparison groups were examined for serum tissue factor (TF) activity; tissue factor pathway inhibitor (TFPI) and potential to generate thrombin in calibrated thrombography test.

Results. Patients with developed ePE vs. control group were found to have significantly increased TF activity at both time points: 49.1 pmol/ml vs. 5.3 pmol/ml (p < 0.0001) and 56.7 pmol/ml vs. 6.6 pmol/ml (p < 0.0001); respectively. At gestational age of 19–21 weeks; patients in the study vs. control group had serum TFPI level significantly lower (1.1 U/ml vs. 1.6 U/ml; p < 0.0001) that was significant elevated up to 2.1 U/ml by 82 % at 27–28 weeks of pregnancy. At both time points; a significantly increased thrombin generation was detected in women with developed ePE.

Conclusion. The development of ePE is characterized by increased potential to generate thrombin. TF has been identified as a more sensitive marker of activated coagulation hemostasis; and its significantly increased activity was recorded at gestational age of 19–21 weeks that allows us to consider TF as a prognostic biomarker.

Aim: to investigate an association between polymorphism in the MMP2, MMP8, MMP9 genes and severe breast cancer (BC).

Materials and Methods. Retrospective comparative study was conducted by assessing a cohort of 345 BC patients: 254 patients at stage I–II and 91 at stage III–IV. Genotyping of the three single nucleotide polymorphisms in the MMP2 (C>T rs243865), MMP8 C>T rs1940475), and ММР9 (C>T rs3918242) genes was performed. A comparative analysis of the genetic characteristics of patients with stage I–II and stage III–IV of the disease was performed.

Results. The allele variant T rs1940475 (C>T) of the MMP8 gene in BC patients at stage I–II (0.512) was found by 1.2-fold more often compared with patients at stage III–IV of the disease (0.428; pperm = 0.05). According to allelic (odds ratio (OR) = 0.71; 95 % confidence interval (CI) = 0.51–1.00; pperm = 0.05) and additive (OR = 0.69; 95 % CI = 0.48–0.99; pperm = 0.05) genetic models, the allele T rs1940475 (C>T) of the MMP8 gene has protective effect for developing stage III–IV BC. The polymorphic locus rs1940475 (C>T) determines the amino acid substitution in the MMP8 protein (p.K87E) and DNA binding to the transcription factors NF-AT1, MYC and CIZ, is associated with the expression of the genes MMP27 and RP11-817J15.3 acting as an enhancer regulatory site in primary breast epithelial cells. Single nucleotide polymorphism in the MMP2 (C>T rs243865), ММР9 (C>T rs3918242) genes is not associated with severe BC (stages III–IV).

Conclusion. The single nucleotide polymorphism rs1940475 in the MMP8 gene is a protective factor protecting against severe BC course.

Introduction. Radical surgery for recurrent atypical endometrial hyperplasia (AEH) allows to fully assess pathological changes of the endometrium, a risk of concomitant cancer, and provides insight into proposing a definitive therapy. However, after ovariohysterectomy, young women develop postovariectomy syndrome (POES) and psychosexual disorders profoundly decreasing quality of life (QoL) that requires rehabilitation measures.

Aim: to conduct a comparative analysis of QoL in patients with recurrent AEH after hysterectomy with bilateral salpingooophorectomy based on the management tactics in the rehabilitation period.

Materials and Methods. In the second part of the prospective randomized comparative study, 58 women diagnosed with recurrent AEH (mean patient age 44.25 ± 3.40 years) underwent a one-year-follow-up, divided into 2 groups according to the management tactics in the rehabilitation period: group 1 – 27 patients with "active" rehabilitation according to the complex rehabilitation and therapeutic protocol proposed by our research group; group 2 – 31 patients with "passive" rehabilitation. To assess the overall QoL, a questionnaire the Functional Assessment of Cancer Therapy for Patients with Endometrial Cancer (FACT-En) was used, analyzing a level of anxiety and depressive disorders with the Hospital Anxiety and Depression Scale (HADS) as well as manifestations of surgical menopause using Kupperman–Uvarova modified menopausal index (MMI) and sexual function – with the Female Sexual Function Index (FSFI) on day 3–7 as well as 3, 6, 12 months after surgical treatment.

Results. It was found that inter-group difference was significant in the FACT-En questionnaire observed as early as by 3 months of the study, whereas by 12 months the QoL score in the "active" rehabilitation group increased by 39.36 points based on the FACT-En questionnaire, but only by 17.38 points in the "passive" rehabilitation cohort (p < 0.001). Analyzing Kupperman–Uvarova MMI, the degree of manifested surgical menopause decreased over time in both groups. However, as early as 6 and 12 months after onset, “active” rehabilitation was featured with surgical menopause parameters corresponding to a mild course, whereas “passive” rehabilitation was associated with moderate severity (p < 0.001). Over the entire follow-up period, "active" rehabilitation group was shown to have anxiety parameters decreased from 10.77 ± 2.36 score (subclinical anxiety) to 4.55 ± 1.50 score (normal range), whereas at 6 and 12 months of follow-up the "passive" rehabilitation group was found to have anxiety parameters corresponding to subclinical manifestations. Over time, sexual function improved in both groups, however, the parameters in the "active" vs. "passive" rehabilitation group were significantly higher as early as 3 months after the onset, with similar pattern observed at 6 and 12 months (p < 0.05).

Conclusion. The set of rehabilitation measures proposed by us improves psycho-emotional state, corrects POES manifestations, improves sexual function of AEH patients, thereby increasing overall QoL. This is comparable to the results of medical rehabilitation of women after radical treatment with endometrial cancer.

Introduction. Thrombosis is a formidable complication of the oncological process that still profoundly contributes to overall mortality despite the anticoagulant use. According to the recent data, thrombosis in cancer represents a special type of prothrombotic state, wherein thromboinflammationis one of its constituents. In addition, thromboinflammation contributes both to the disease progression and intensity of metastasis processes. Recently, a large number of studies worldwide have been devoted to investigating thromboinflammation in cancer patients.

Aim: to assess NETosis activity (the process of neutrophils extracellular traps synthesis), namely, the concentration of citrullinated histone H3 (citH3) as a blood plasma NETosis marker in women with malignant genital organs and breast neoplasms.

Materials and Мethods. The prospective observational controlled non-randomized study included 45 patients (main group) with malignant neoplasms of uterus body, ovaries, cervix (adenocarcinoma of the cervical canal) and mammary glands admitted to the hospital for planned surgical treatment (13, 15, 5 and 13 patients, respectively) and 33 women with benign neoplasms of the genital organs and mammary gland (control group). The plasma citН3 concentration was determined using an enzyme immunoassay.

Results. It was found that cancer patients had citН3 concentration significantly increased (1.434–2.058 ng/ml) compared with the control group (0.281–0.371 ng/ml). The concentration of citH3 in patients with tumors of the uterine body and cervix ranged from 2.271 to 2.992 ng/ml, patients with ovarian tumors – from 1.357 to 2.123 ng/ml, patients with breast tumors – from 0.331 to 0.859 ng/ml. The study revealed no significant differences in the citH3 concentration in patients with breast tumors compared to the control group. Upon elevating citН3 concentration, such parameters as C-reactive protein, D-dimer, neutrophils and platelets count, as well as neutrophils/lymphocytes ratio were significantly increased. Significant differences were revealed in platelet count in the main group (236,68–273,77×109/L) vs. control group (178,14–202,35×109/L).

Conclusion. The study demonstrated the activation of NETosis in patients with tumors of the uterine body as well as cervix (adenocarcinoma) and ovaries that might be combined with hemostasis activation and systemic inflammatory response.

Aim: to study the factors leading to adverse perinatal outcomes allowing, on this basis, to predict degree of perinatal risk.

Materials and Methods. The medical records of 155 patients who performed delivery in 2019–2021 were retrospectively analyzed. The following groups were formed: main group included 56 patients with adverse perinatal outcomes (9 fetuses died antenatally, 36 fetuses born below Apgar score 5, 9 newborns died within the first 168 hours of extrauterine life, 2 infant deaths). The control group included 99 patients with favorable perinatal outcomes. While assessing the data retrieved from medical records, sociobiological and laboratory-instrumental indicators, obstetric-gynecological and somatic anamnesis, the presence of extragenital pathology, the delivery process, information related to child condition at the time of birth and in early neonatal period were analyzed.

Results. In patients of the main group, significant differences were revealed compared to control group, respectively: high parity (3 or more deliveries) – 11 (19.6 %) and 15 (15.1 %) (p = 0.001); vomiting of pregnant women in early gestation – 27 (48.2 %) and 14 (14.1 %) (p = 0.005); the presence of uterine scar after two or more caesarean sections – 7 (12.5 %) and 2 (2.1 %) (p = 0.009); former abortions – 24 (42.8 %) and 16 (16.1 %) (p = 0.0017); acute respiratory viral infection in the first trimester – 21 (37.5 %) and 13 (13.1 %) (p = 0.005); threatened abortion in the second trimester – 23 (41.0 %) and 15 (15.1 %) (p = 0.0005); Doppler-based blood flow disorders in the second trimester – 17 (30.3 %) and 11 (11.1 %) (p = 0.008) and in the third trimester – 9 (16.0 %) and 3 (3.0 %) (p = 0.006); altered amniotic fluid index according to ultrasound data in the second trimester – 6 (10.7 %) and 1 (1.0 %) (p = 0.011); intrauterine growth retardation in the third trimester – 15 (26.7 %) and 4 (4.0 %) (p = 0.012); severe preeclampsia – 6 (10.7 %) and 1 (1.0 %) (p = 0.04). In patients of the main group, pregnancy was finished prematurely in 41.1 % of cases compared to 100% term delivery in control group.

Conclusion. The risk factors identified, which were manifested in the first and second trimesters of pregnancy may be predictors for adverse perinatal outcomes. Based on the study results for patients of the main and control groups, it was convinced that the topic of predicting favorable and unfavorable perinatal outcome is currently far from being disclosed, which is a long meticulous path of search, analysis and comparison.

Aim: to analyze diagnostic potential of early and late fetal growth retardation (FGR) based on examining significance of serum autoimmune antibody (АВ) level.

Materials and Methods. A single center prospective cohort comparative study included 98 pregnant women: 79 with FGR (main group I) and 19 with physiological course of pregnancy (comparison group II). Depending on the time of manifestation, pregnant women with FGR were divided into 2 subgroups: early FGR (subgroup IA, n = 41) and late FGR (subgroup group IB, n = 38). All patients underwent venous blood sampling to determine the serum autoimmune AB level against 12 human self-antigens using the ELI-P-Test: for human chorionic gonadotropin antigen (hCG), DNA, β2-glycoprotein (β2-GP), collagen, fragment crystallizable of immunoglobulin G (Fc-IgG), insulin, thyroglobulin, S100 protein, surface antigen of germ cell and prostate (Spr), thrombocyte membrane protein (TrM), antineutrophil cytoplasmic antibodies (ANCA), and membrane antigen of glomerular cells (KiMS). Venous blood sampling was carried out in the main group at the time of establishing FGR diagnosis (the third trimester of pregnancy in all cases): early manifested FGR – 29 [28; 31] weeks, late manifested FGR – 5 [33; 36] weeks, comparison group II – 33 [32; 35] weeks.

Results. To diagnose early FGR, the level of the following autoimmune АВ was shown to be significantly increased against hCG, collagen, S100 protein, TrM, ANCA, KiMS (p = 0.037; р = 0.001; р = 0.013; р = 0.005; р = 0.003; p < 0.001, respectively), whereas late FGR was diagnosed based on measuring АВ against DNA, collagen, insulin, S100 protein (p = 0.002; p = 0.003; p = 0.010; p < 0.001, respectively).

Conclusion. Detecting autoimmune antibodies has shown its informative importance in pregnant women with FGR, so that changes in serum autoantibody level may serve as a laboratory marker of early and late FGR.

Here, we review publications aimed at assessing the prevalence of intracranial hemorrhage, types of hemorrhage in pregnant patients, diagnostic features, as well as the basic principles of treatment used in such cases. There a represented pathologies in pregnant women such as subarachnoid, subdural, extradural hemorrhage, thrombosis of cavernous sinuses, arteriovenous malformations, neoplasms. There are summarized data within the years from 2015 to 2020 retrieved from the search databases PubMed/MEDLINE, Google Scholar, and Web of Science. Based on our study, it was concluded that intracranial hemorrhages during pregnancy most often occur in the third trimester. This is due to several factors: development of preeclampsia, increased blood pressure, coagulopathy, HELLP-syndrome, physiological remodeling of cerebral autoregulation, and concomitant initial pathology of cerebral vessels such as aneurysms and arteriovenous malformations. We also draw special attention to the importance of timely differential diagnostics of hypertensive conditions during preeclampsia and neurosurgical pathology requiring urgent intervention.

Nowadays, the management and delivery of multiple pregnancies in the era of increased rate of multiple pregnancies is essential in work of an obstetrician-gynecologist. However, it is an ultrasound scanning that becomes a starting point to choose management strategies for multiple pregnancies. Despite tremendous advances in understanding the pathogenesis of developing specific complications, multiple pregnancies still account for a large proportion of perinatal complications. Therefore, continuously improving knowledge in antenatal diagnostics, the principles of prenatal care and optimal approach to delivery is fundamental for reducing morbidity and mortality rate related to multiple pregnancies.

Introduction. Aortic dissection (AD) is a rare and extremely dangerous pathology in obstetrics and gynecology. AD frequency in pregnant women comprises only 14.5 cases per 1 million subjects and leads to maternal death in 30 % cases. AD is characterized by the difficulty in performing differential diagnostics.

Aim: to describe a clinical case demonstrating the difficulties in timely AD diagnostics and treatment during delivery.

Materials and Methods. A rare clinical case of asymptomatic AD resulting in death of the woman in labor is presented after assessing the patient medical history, the conclusion of the pathoanatomical examination and the protocol of the mortality review.

Results. The presented AD clinical case in labor with subtle clinical symptoms demonstrate the extreme difficulty of timely diagnostics of this pathology for practitioners, which inevitably resulted in maternal mortality.

Conclusion. AD during pregnancy and labor is the condition with extremely rare and difficult diagnostics, high probability of maternal and perinatal mortality, which should be known and remembered by obstetrician-gynecologists.

Primary health care specialists play one of the defining roles in shaping treatment and diagnostic strategy by attracting colleagues from related specialties, including those dealing with medical genetic counseling. At the current stage, additional examinations allow to implement a patient-oriented integrated approach. Genetic studies can substantially improve quality of diagnostics and should be more actively used in primary care. This confirms the clinical observation using extended diagnostic tactics in the patient with non-specific complaints and a burdened obstetric history.

The laws of fundamental science dictate the rules of thinking. And the latter, in turn, form the methodology of science. With the discovery of the second law of thermodynamics, it became possible to approach the issues of the universe in a different way, in this case – to the issues related to organization of living matter. In this respect, the principle of elimination has been reflected at all levels of living matter being not only the achievement in cognition, but also a prospective motivation for our actions.

Here we outline historical aspects of the life and scientific activity of Robert Gwyn Macfarlane emphasizing on his contribution to investigating issues related to blood coagulation.