Introduction. Pregnancy management in post-thrombotic women is challenging, because women with previous episode of venous thromboembolic complications (VTEC) have a 3–4 times higher risk of its exacerbation during than outside of subsequent pregnancies.
Aim: to improve effective prenatal counseling program for women with former venous thrombosis and ischemic stroke to prevent recurrence of arterial and venous complications as well as pregnancy outcomes for mother and fetus.
Materials and Methods. A single-center observational study was conducted involving 50 patients with arterial and venous thrombosis and pregnancy complications in anamnesis and 40 patients with a physiological course of pregnancy. To improve existing methods of thrombosis prevention, risk factors such as gene polymorphisms for plasminogen activator inhibitor-1 (PAI-1), coagulation factor II (prothrombin; F2: Thr165Met), coagulation factor I (fibrinogen; FGB I/D) were investigated as potential new candidates of thrombosis risk markers in pregnant women and puerperas.
Results. In 24 (48 %) of 50 women with former arterial and venous thrombosis and pregnancy complications, were found to develop thromboembolic complications during pregnancy. Risk assessment performed according to the existing thrombosis risk scales, revealed that only 7 (29.2 %) patients were considered as candidates for thromboprophylaxis and received anticoagulant therapy. The remaining 17 women who subsequently developed thrombosis received no anticoagulant therapy. Unfortunately, most women were not tested for thrombophilia despite a history of pregnancy complications (fetal loss, preeclampsia, fetal growth retardation). The hereditary thrombophilia of high thrombogenic risk occurred in 5 (20.8 %) of 24 women with thrombosis during pregnancy (3 – homozygous forms of factor V Leiden mutation, 1 – reduced protein C and 1 – deficiency of protein S and antithrombin). Circulation of various types of antiphospholipid antibodies was found in 13 (54.2 %) of 24 women. Homozygous polymorphisms of the PAI-1 4G/4G (45.8 %) and prothrombin F2 Thr165Met (20.8 %) genes were significantly more common in women with former thrombosis and obstetric complications compared with the control group (p < 0.001 and p = 0.023, respectively; odds ratio = 6.744; 95 % confidence interval = 1.195–38.056).
Conclusion. In all cases examined, 24 women with thrombosis during pregnancy revealed to suffer from hereditary or acquired thrombophilia of high thrombogenic risk. After exclusion of high-risk thrombophilia, a number of gene polymorphisms exist that may be new candidates as a risk factor for thrombosis in pregnant women. More than 50 % of thrombosis cases in our study were associated with the homozygous genotype PAI-1 4G/4G (p < 0.001) and F2 Thr165Met (p < 0.001).

Aim: to determine reference values of angiogenic factors dynamics in pregnancy for female patients with twins and different types of placentation for early diagnostics and assessment of preeclampsia (PE) severity.
Materials and Methods. There was conducted 2020–2021 prospective study enrolling 93 females with twin pregnancy to examine 68 with dichorionic diamniotic (DCDA) twins and 25 with monochorionic diamniotic (MCDA) twins. All patients were divided into 2 groups: group I consisted of 65 women with twin pregnancy without PE, group II included 28 women with twin pregnancy complicated by PE. In blood serum of pregnant women the level of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and their ratio were studied for diagnosing and predicting PE severity at 4 time points of gestation (20.0–23.6 weeks, 24.0–28.6 weeks, 29.0–33.6 weeks, 34.0–36.6 weeks).
Results. No significant difference was found in angiogenic factors level and their ratio in pregnant women with uncomplicated DCDA and MCDA twins. Regardless of placentation type, sFlt-1/PlGF ratio in women with twin pregnancy and PE at 24 weeks of gestation was 103.3, by 20-fold exceeding this level than in uncomplicated twin pregnancy. Cut-off values for sFlt-1/PlGF ratio were determined allowing highly reliable to rule out diagnosis PE (sFlt-1/PlGF < 21.85; sensitivity 100 %, specificity 85 %) and to diagnose PE (sFlt-1/PlGF > 49.4; sensitivity 71.1 %, specificity 100 %). The sFlt-1/PlGF ratio was higher in pregnant women with severe PE compared with the moderate degree of the disease throughout pregnancy (р < 0.05). In pregnant women with early PE, the angiogenic factors ratio exceeded the upper threshold value from 24 weeks of gestation, with late PE – from 34.0–36.6 weeks. Significantly higher sFlt-1 level (18359 ± 8656 pg/ml vs. 5526 ± 2808 pg/ml; р < 0.001) and the sFlt-1/PlGF ratio (118,0 ± 65,2 vs. 32,8 ± 18,6; р < 0.03) as well as severe degree of PE were noted in patients with induced twin pregnancy from 24.0–28.6 weeks of gestation compared with spontaneous multiple pregnancy (42,2 and 22,2 % respectively; p < 0,05).
Conclusion. The developed reference values of the sFlt-1/PlGF ratio in pregnant women with twins and different types of placentation can be used not only to diagnose PE, but also to assess the severity and timing of the disease manifestation.

Aim: assessing efficacy and safety of intravenous laser blood irradiation (ILBI) in patients with inflammatory diseases of the uterine appendages (IDUA).
Materials and Мethods. There were enrolled 130 women with IDUA divided into 3 groups: group 1 (main group) – 40 patients who received traditional drug therapy combined with ILBI; group 2 (comparison group) – 40 patients who received only traditional drug treatment; group 3 (control group) – 50 patients who received no treatment. All patients underwent a standard clinical and laboratory examination, pelvic ultrasound examination, morphology assessment of peripheral blood erythrocytes, and examination of serum cytokine level. Pain intensity was assessed using the Verbal Rating Scale (VRS). In patients of groups 1 and 2, all clinical and laboratory parameters were determined at hospital admission and discharge (on day 7–10), and revealing potential long-term consequences and the onset of pregnancy were analyzed by telephone survey (3–6 months after treatment).
Results. In group 1, 7–10 days after treatment, there were revealed normalized parameters of general blood test (90 % of patients), as well as erythrocyte dry mass (35.42 ± 1.98 pg), the normal discocyte count (87,5 % of women) and the size erythrocyte central cavity (60 % of women). Also, the coagulogram parameters returned to normal range; cytokine level decreased as follows: interleukin-1β (70.46 ± 6.08 pg/ml), interleukin-6 (10.86 ± 1.26 pg/ml), tumor necrosis factor-α (5.82 ± 1.48 pg/ml). According to ultrasound data, the presence of hydatids of the fallopian tubes and hydrosalpinxes was not noted, the ovarian volume and the tubal thickness decreased; pathology of the pelvic organs was not detected in 72.5 % of women. 85.5 % of patients in group 1 had decreased and increased level of Gram-negative and Gram-positive as well as Lactobacilli, respectively, that was higher by 15.5 than in group 2. After 3–6 months of discharge from hospital, 35 % of subjects in group 1 became pregnant that was by 2.5-fold more common than in patients who received only traditional drug therapy. In addition, complications and exacerbations in group 1, were not observed in 92.5 % of cases exceeding by 1.3-fold those found in group 2.
Conclusion. Conducting ILBI in patients with IDUA leads to normalized erythrocyte morphology, hemostasiogram parameters, serum cytokine levels, decreased inflammatory changes in the uterine appendages, emptying of hydrosalpinxes, pain relief assessed by VRS, normalized menstrual-ovarian function, and vaginal microbiocenosis. While applying standard drug therapy combined with ILBI, exacerbations and complications were less common, and pregnancy occurred more often 3–6 months after treatment.

Introduction. Obstetric hemorrhage associated with placental abnormalities holds a leading place in the pattern of massive hemorrhage and maternal mortality, have been increasingly relevant due to the elevating rate of abdominal delivery.
Aim: to assess fetal condition, parameters of uteroplacental and fetal hemodynamics as well as perinatal outcomes in pregnancy complicated with placenta previa.
Materials and Methods. The retrospective study included 112 women aged 18–38 years who performed delivery between January 2016 and September 2020. Two groups were formed: the main group – 42 patients with placenta previa, and the control group – 70 pregnant women with normal placentation. Examination of women was carried out at admission for delivery within the gestational age between 26 to 40 weeks. We studied the parameters of fetometry and dopplerometry, hemogram parameters, biochemical blood analysis and some hemostasis parameters.
Results. The groups examined were comparable in age and anthropometric data. In the main vs. control group, the course of pregnancy was more often complicated by the threatened termination (45 % vs. 21 %; p = 0.03), anemia (hemoglobin level 107 g/L vs. 110 g/L; p = 0.044), fetal growth retardation. Assessment of uteroplacental state and fetal-placental blood flow revealed differences indicating the presence of pathophysiological basis for developing hypotrophy and fetal hypoxia in the group of women with placenta previa. In the main group, the average gestational age at the time of delivery was 35.0 ± 2.8 weeks, in the control group – 39.0 ± 1.3 weeks (p = 0.003). Delivery showed significantly increased risk of preterm birth and rate of neonatal respiratory disorders in the main group.
Conclusion. The results obtained evidence about a need to provide a careful approach to manage pregnant women with placenta previa to timely prevent anemia, placental disorders and hypotrophy. At the stage of the level III obstetric hospital, it is necessary to be ready for decompensation of placental disorders, birth of children with respiratory disorders, and fetal growth retardation.

Introduction. Despite that ovarian carcinosarcoma (OCS) is an extremely rare disease, it is of great medical and social importance by taking into account very high level of overall mortality, recurrence, metastasis, and economic costs.
Aim: to summarize current data on various aspects of OCS.
Materials and Methods. The search strategy for English written papers published in databases PubMed/MEDLINE, Scopus, Web of Science, Google Scholar was based on the following keyword queries: «ovarian carcinosarcoma», «etiology and pathogenesis», «epidemiology», «classification», «clinical picture», «diagnosis», «treatment». The search depth was limited within the years 2010–2022, by prioritizing the search depth within the last 5 years (2017–2022).
Results. We found 48 articles in English, published from 2016 to 2022, of which 47 (97.9 %) articles were published within the last 5 years. Scientific data are represented by studies with a small patient sample and with low evidence base. The results of the analysis for identified publications showed a limited, fragmented and inconsistent scientific data both in terms of etiology, pathogenesis and treatment, as well as an impact of OCS stages, age and other risk factors on the likelihood of relapses.
Conclusion. The lack of extensive clinical studies along with observed substantial number of controversial issues may be accounted for by OCS low prevalence and complex pathogenesis. Nevertheless, the results obtained during the generalization of scientific knowledge provide a realistic insight into the current state of global science about this medical and social disease and may be used to improve the diagnostics and treatment of OCS patients.

The von Willebrand factor (vWF) is a multimeric plasma glycoprotein, which quantification has important prognostic value. The current literature review demonstrates a relationship between the disease severity and vWF level. For example, von Willebrand disease is characterized by a quantitative/qualitative genetic vWF deficiency resulting in potentially developed massive bleeding, which knowledge can prevent development of formidable complications. We should also not forget about an opportunity of developing acquired Willebrand syndrome most often occurring in response to autoimmune diseases. A marked vWF increase during pregnancy may evidence about developing preeclampsia, whereas in newborns exposed to additional risk factors, it can lead to thrombosis. In cancer patients, a substantially elevated vWF level correlates with low survival, especially in those with ovarian cancer, glioblastomas, esophageal and lung cancer. The emergence of a novel coronavirus infection COVID-19 allowed us to take a fresh look at prognostic value of vWF, because numerous studies show that increased blood plasma vWF:Ag is associated with more adverse outcome in patients with COVID-19. Here, we demonstrate an importance of determining vWF level, because early diagnostics and treatment can improve the outcomes of all such patients.

Nowadays, photodynamic therapy (PDT) is a high-technology actively developing treatment method used in clinical medicine. An interest in this method is primarily due to the fact that its destructive action is based on the mechanisms of free radical oxidation, altered tumor vascular stroma and immune cell-mediated elimination. Owing to current research, improving the quality of photosensitizers and light sources, it becomes possible to expand indications for using this method beyond oncological practice. Generalized data on PDT effectiveness and safety for the treatment of cervical lesions, as well as the ease to use, allow us to attribute this technique to some promising approaches.

Studies of the pathogenesis of thrombosis and inflammation and their contribution to tumor progression and metastasis in cancer patients, initiated many decades ago, have been continued to this day. At the same time, thrombosis and inflammation are inextricably linked to each other. One of the central places in thromboinflammation is held by the loss of normal antithrombotic and anti-inflammatory function in endothelial cells, which leads to dysregulated coagulation, imbalanced the complement system, platelet activation and recruitment of leukocytes in the microvasculature. In turn, tumor cells affect the hemostasis by releasing procoagulant substances, activating fibrinolysis, proteolysis, increasing platelet activation and aggregation, releasing adhesion molecules, secreting pro-inflammatory and pro-angiogenic cytokines. Future research aims to advance an understanding of thromboinflammation in oncology, particularly focusing on the role of platelets beyond hemostasis and thrombosis, as well as some new players in the process. In the future, the main attention will be paid to investigating molecular mechanisms that regulate cancer-related thromboinflammation, providing insights into mechanisms underlying both inflammation and thrombosis as pathogenetic components in cancer patients. Altogether, it will provide an opportunity to create new, modern strategies to treat cancer patients.

Infertility is a disease of the reproductive system characterized by lacked clinical pregnancy after 12 or more months of regular unprotected sex. To diagnose the causes and choose the tactics of infertility treatment, a personalized approach to each patient is required, which is beneficial for both the doctor and the patient. A comprehensive examination of patients is important from the point of pharmacoeconomics and clinical efficiency view. Here, a comprehensive diagnostics of the spouses resulting in birth of a healthy child is discussed.

Here, we describe the historical aspects of the life and scientific work of Karl Rokitansky as well as his contribution to the medicine.

On October 4, 2022, the II International Conference "Interdisciplinary Problems of Thrombosis, Hemostasis and Antithrombotic Therapy" was held in a hybrid (face-to-face and online) format with the participation of employees of the Department of Obstetrics and Gynecology at the Sechenov University, leading Russian and foreign experts in the field of high-risk pregnancy, thrombosis and hemostasis. The conference became a landmark event in the life of the scientific community and was highly appreciated by the audience.