Aim: to study the features of thrombotic complications in cancer patients during COVID-19 infection, and identify the most significant diagnostic and prognostic criteria.

Materials and Methods. Within the framework of cohort non-randomized study, there were analyzed the course of coronavirus infection in 72 hospitalized patients with uterine cancer (n = 22), cervical cancer (n = 19), ovarian cancer (n = 24) as well as vaginal and vulvar cancer (n = 7). All patients hospitalized for COVID-19 were examined and treated in accordance with the Interim guidelines “Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)” effective at the time of therapy. Additionally, on days 3–7 after hospitalization, a blood test was performed once to determine the level of metalloproteinase ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), ADAMTS-13 activity, ADAMTS-13 inhibitor and von Willebrand factor (vWF) level.

Results. It was shown that the average age of the patients was 56.96 ± 7.55 years, the length of hospitalization ranged from 7 to 19 (13.0 ± 3.79) days. The disease severity was assessed by the degree of lung tissue damage based on computed tomography (CT), respiratory failure and development of systemic inflammatory response syndrome (SIRS). During hospitalization, CT-2 was detected in 46 (63.9 %) patients, CT-3 – in 26 (36.1 %) patients; 37 (51.4 %) patients were transferred to the intensive care unit (ICU). Clinically significant deep vein thrombosis (DVT) was diagnosed in 9 (12.5 %) patients, and pulmonary embolism (PE) – in 4 (5.6 %) patients. Of these, 6 cases of DVT and 3 cases of PE were fatal. A total of 14 (19.44 %) patients deceased due to developing acute cardiopulmonary failure. A vWF/ADAMTS-13 ratio greater than 2.1 was found in all ICU patients. Despite anticoagulant therapy, patients with DVT and PE had this ratio higher than 3.3 (4.00 ± 0.48), whereas in all 14 deceased patients it exceeded 2.98.

Conclusion. Venous thromboembolism, including PE and DVT, has been identified as а serious complication of COVID-19. An opportunity to predict them early is of special importance because they may lead to serious complications such as disseminated intravascular coagulation, SIRS, cardiopulmonary failure, and death. In patients suffering from cancer infected with COVID-19, not only a decline in ADAMTS-13 activity and level was detected, but also a parallel increase in vWF level. A vWF/ADAMTS-13 ratio may be an early indicator of COVID-19 severity in such patients: a vWF/ADAMTS-13 ratio exceeding 2.1 was common for all ICU patients. Hence, it evidences about a potential for using this parameter to early identify such risk patients who may require more intensive care and medical intervention.

Introduction. The prevalence of bacterial vaginosis (BV) comprises 23–29 %, which in pregnant women is a known risk factor for premature birth (PB) that rates increases by 2.9-fold. BV treatment with antibiotics has no effect PB incidence, therefore stressing a need to search for alternative remedies.

Aim: to evaluate the effectiveness of treatment, including antibacterial therapy and a complex preparation containing natural antimicrobial peptides and cytokines, to reduce the incidence of birth defects in pregnant women with BV.

Materials and Methods. Design: a prospective open comparative cohort study in parallel groups was conducted with 101 pregnant women: Group I (n = 69) received the antibiotic Metronidazole, 500 mg tablets orally twice a day for 7 days, and a complex preparation containing exogenous natural antimicrobial peptides and cytokines (Superlymph^®) suppositories per 25 IU once a day vaginally in the evening for 20 days; Group II (n = 32) received Metronidazole alone (the same regimen). Patient examination was carried out using approaches included clinical methods, accepted in obstetrics, and laboratory tests – microscopy of vaginal content smears, real-time polymerase chain reaction (PCR).

Results. The PB (within 24⁰–36⁶ weeks) incidence in Group I was significantly lower than in Group II and comprised 2.9 % vs. 21.9 %, respectively (p = 0.004), with an 8-fold decline in developing PB risk (relative risk (RR) = 0.13; 95 % confidence interval (CI) = 0.03–0.60), whereas inter-group percentage of pregnant women with high risk (PB history) was comparable (p = 0.39) so that PB incidence did not differ from pregnant women without former PB. Microbiological recovery after treatment for BV was achieved in 85.5 % of patients from Group I vs. 56.3 % in Group II (RR = 1.52; 95 % CI = 1.10–2.10; p = 0.002) based on real-time PCR data. The persistence of anaerobic flora after treatment was significantly lower in Group I vs. Group II reaching 7.2 and 34.4 % (p < 0.001), respectively, with a 5-fold lower PB risk (RR = 0.21; 95 % CI = 0.08–0.56). Cessation of viral shedding compared to the number of patients with initial viral shedding was achieved in 94.6 % vs. 8.3 % of patients, respectively, with a 50-fold decline in risk (RR = 0.02; 95 % CI = 0.005–0.08; p < 0.001). The number of newborns weighing less than 2500 g was significantly lower from paired mothers who received Superlymph^® + Metronidazole comprising 2.9 % vs. 15.6 % treated with Metronidazole alone (p = 0.03), whereas a risk of low birth weight neonates was decreased by 6-fold (RR = 0.16; 95 % CI = 0.03–0.88). The condition of the neonates assessed by birth Apgar score was comparable.

Conclusion. The use of a complex preparation Superlymph^® (suppositories per 25 IU once an day vaginally, for 20 days) along with oral antibiotic Мetronidazole in pregnant women with BV facilitates a decline in PB incidence down to 2.9 % at gestational age of 24⁰–36⁶ weeks lowering a risk of PB exceeding that of antibacterial therapy by 8-fold, including patients with former PB.

Aim: to develop a model for predicting preeclampsia (PE) based on the clinically most significant differentially expressed plasma microRNAs.

Materials and Methods. A prospective observational comparative study was conducted with 62 women, divided into two parallel groups: 32 patients with PE and 30 clinically healthy women with uncomplicated pregnancy. Transcriptomic analysis was performed to identify differentially expressed blood plasma microRNAs using next generation sequencing (NGS).

Results. Calculation of risk ratios for PE development allowed to identify 14 plasma microRNAs that influence the development of PE pathology. PE-associated microRNAs hsa-miR-103a-3p, hsa-miR-451a and hsa-miR-516a-5p have a high diagnostic value when combined to assess their blood plasma expression level in early pregnancy stages.

Conclusion. The developed prognostic model can be applied to pregnant women at risk for PE development, which may further reduce obstetric complications and improve perinatal outcomes.

Aim: to increase the clinical effectiveness and safety of apical prolapse treatment by applying anterior bilateral sacrospinous fixation (SSF) with a polypropylene mesh implant.

Materials and Methods. A single-center open prospective comparative clinical study in parallel groups in parallel groups was carried out at the Clinic of Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology. There were examined and treated 155 patients with stage II–IV symptomatic genital prolapse according to the Pelvic Organ Prolapse Quantification System (POP-Q) who underwent various variants of SSF. The patients were stratified into 3 groups: group 1 (LPSSF) – 34 patients with symptomatic apical genital prolapse who underwent SSF through the posterior vaginal wall using LPSSF ligatures (ligature posterior sacrospinous fixation); group 2 (LASSF) – 42 patients with symptomatic apical or anterior-apical genital prolapse, who underwent ligature SSF using the anterior approach LASSF (ligature anterior sacrospinous fixation); group 3 (MESH TASSF) – 79 patients with symptomatic apical or anterior-apical genital prolapse, who were treated by applying the anterior bilateral SSF method using synthetic tape MESH TASSF (tape anterior sacrospinous fixation). The frequency of intra- and postoperative complications, patient complaints, and relapse rates were assessed post-surgery. Functional outcomes were assessed using the PFDI-20 questionnaire (Pelvic Floor Distress Inventory-20) at 3, 6 and 12 months after treatment. Patients in group 3 were treated by applying a method we developed for correction of apical genital prolapse and concomitant cystocele reconstruction.

Results. The method presented here was characterized by a lower blood volume loss compared to posterior SSF, minimized intra- and postoperative complications: decreased incidence of hematomas, buttock pain, rate of urinary disorders (stress incontinence, mixed forms of urinary incontinence, urgent urinary incontinence, urinary difficulty, bladder hypotension). Applying MESH TASSF fixation allowed to decrease duration of hospital treatment and alleviate pain severity in the postoperative period, and additionally contributed to improved patients' quality of life sustained for as long as 12 months post-surgery.

Conclusion. The treatment results confirmed that the MESH bilateral SSF method using an anterior approach is clinically effective, relatively safe, and contributes to a markedly reduced rate of disease relapses. The presence of anterior-apical or apical genital prolapse (C or Ba+C prolapse, stages II–IV according to the POP-Q) should be considered as indications for performing anterior bilateral SSF.

Aim: to evaluate the impact of rehabilitation on various components of quality of life (QoL) in patients with vulvovaginal atrophy (VVA).

Materials and Methods. A prospective comparative controlled longitudinal study involved 350 patients with VVA, divided into groups based on the type of menopause: surgical (n = 140) and natural (n = 140), with a control group of 70 women without VVA. Patients were further subdivided into those receiving complex "active" (groups 1A, 2A) and "passive" (groups 1B, 2B) rehabilitation. The study included 6 visits over 24 months, assessing QoL using the Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Modified Menopausal Index (MMI), Well-being, Activity, Mood questionnaire (WAM), Magnesium Deficiency Questionnaire (MDQ), and the Assessment Test of Magnesium Deficiency (ATMD).

Results. Women with surgical menopause had severe sexual dysfunction initially. Complex "active" rehabilitation significantly improved sexual function over time compared to "passive" rehabilitation. Surgical menopausal women had higher initial levels of anxiety and depression. "Active" rehabilitation significantly reduced these levels, reaching normal values within the first year. Patients with surgical menopause exhibited more severe menopausal symptoms. "Active" rehabilitation led to significant reductions in these symptoms, improved well-being, activity, and mood more significantly than "passive" rehabilitation, particularly in the first year. Complex "active" rehabilitation normalized magnesium deficiency indicators within three months, maintaining normal levels throughout the study.

Conclusion. Comprehensive "active" rehabilitation significantly improves sexual function, reduces anxiety and depression, alleviates menopausal symptoms, and enhances overall well-being in women with VVA, especially those in surgical menopause. Personalized rehabilitation programs are crucial for enhancing QoL in these patients.

Introduction. Retained products of conception (RPOC) are detected in 15 % of women after spontaneous or medical abortion. RPOC blind removal from the uterine cavity remains the "gold standard" of surgical treatment, which, however, may be associated with a high risk of certain complications that pose a serious threat to female reproductive function and quality of life. An alternative method for eliminating RPOC proposed by operative hysteroscopy demonstrating the visual control advantages.

Aim: to evaluate clinical effectiveness and safety of RPOC removal in incomplete spontaneous abortion using hysteroscopic morcellation.

Materials and Methods. The prospective comparative study included 135 women with incomplete spontaneous abortion aged 18 to 40 years, divided into 3 groups: group 1 – 42 patients after RPOC electromechanical vacuum aspiration (EVA); group 2 – 44 patients after RPOC manual vacuum aspiration (MVA); group 3 – 49 patients after RPOC hysteroscopic morcellation (HM). In all patients, the level of total endotoxin was measured, metroaspirate cytokine profile was analyzed, the indicator of endometrial microcirculation was assessed before surgical treatment and on day 1 afterwards, and genital ultrasound examination was performed on day 3–5 post-surgery.

Results. In the post-surgical vs. pre-treatment period, the EVA and MVA groups revealed significantly increased levels of total endotoxin and interleukin (IL) IL-1β (p < 0.05). In contrast, these parameters in the HM group changed insignificantly (p > 0.05). In all groups, IL-8 and tumor necrosis factor alpha (TNF-α) levels after surgery were significantly elevated (p = 0.001). In the EVA and MVA groups, levels of anti-inflammatory cytokines IL-4 and IL-10 were markedly decreased (p = 0.001), which did not change in the HM group (p > 0.05). A significantly accelerated microcirculation rate was noted in the EVA and MVA groups while comparing it at pre-surgery level (p = 0.001), but not in the HM group (p = 0.415). Incomplete RPOC removal was reported for 4.5 % MVA patients, all EVA and HM patients had total RPOC elimination. Intraoperative bleeding, uterine perforation were not reported in any examined patient.

Conclusion. The early-stage treatment results showed that RPOC removal by the HM is an effective and safe approach. Limited inflammatory response and stable endometrial microcirculation upon using the HM evidence about a minimal impact on the endometrium that lowers probability of postoperative adhesion.

Obstetric hemorrhages (OH) are the main preventable cause of morbidity, mortality and cases of "near miss" among obstetric complications worldwide. Early preventive measures based on the OH prediction allow to profoundly reduce the rate of female mortality and morbidity as well as prevent the economic costs of patient intensive care, blood transfusion, surgical treatment and long-term hospitalization. Postpartum haemorrhage (PPH) is the most frequent obstetric haemorrhage determined by one of the four causes: a uterine tonus disorder, maternal birth trauma, retention of placenta parts and blood-clotting disorder. There is still a need for the continued search for an accurate and reliable prediction method despite multiple attempts to develop an effective system for predicting OH. The solution to this may be reasonably considered an innovative method such as artificial intelligence (AI) including computer technologies capable of obtaining conclusions similar to human thinking. One of the particular AI variants is presented by machine learning (ML), which develops accurate predictive models using computer analysis. Machine learning is based on computer algorithms, the most common among them in medicine are the decision tree (DT), naive Bayes classifier (NBC), random forest (RF), support vector machine (SVM), artificial neural network (ANNs), deep neural network (DNN) or deep learning (DL) and convolutional neural network (CNN). Here, we review the main stages of ML, the principles of algorithms action, and the prospects for using AI to predict OH in real-life clinical practice.

Compared to children of other ages, neonates especially seriously ill and premature subjects comprise a high thrombotic risk group. A decline in the incidence of neonatal thrombosis may be accounted for by improved treatment of severe conditions in newborns and increased survival of premature infants. Neonatal and adult hemostasis exhibit distinct physiological features: difference in concentration, synthesis rate of blood coagulation factors, metabolic rate, thrombin and plasmin levels. At the same time, neonatal threshold values for natural blood coagulation inhibitors (protein C, protein S, antithrombin, heparin cofactor II) and vitamin K-dependent coagulation factors (FII, FVII, FIX, FX) are quite low, whereas that of FVIII and von Willebrand factor exceeds those found in adults. Thus, newborns have lower plasma fibrinolytic activity. The main risk factors for developing thrombotic complications are as follows: central venous catheters, altered body fluid volume, liver disease, as well as sepsis and inflammatory processes particularly COVID-19. The significance of congenital and acquired maternal and neonatal thrombophilia may pose an additional risk factor for thrombotic complications. Low-molecular weight heparins are the first-choice drugs in treatment and prevention of neonatal thrombosis.

Embryo implantation is the first key step in successful pregnancy, but implantation failures remain quite common in patients undergoing assisted reproductive technology (ART) programs. The main known factors of repeated implantation failures (RIF) in patients undergoing ART are unhealthy lifestyle, genetic factor and low gamete quality, uterus pathology, endometriosis and adenomyosis, thrombophilia as well as male factor and embryonic factors. RIF factors and ways to overcome them have received much attention. Despite multiple RIF causes being identified, the underlying etiology and management remain poorly investigated. In clinical practice, studies and interventions providing no clear scientific rationale or convincing evidence on their effectiveness due to the lack of standardized diagnostic and treatment methods that are often used. An effective strategy for treating RIF risk factors is necessary to increase chances for successful pregnancy in ART programs.

Primary hyperparathyroidism (PHPT) in pregnant women is a rare condition, often remaining undiagnosed due to non-specific clinical symptoms. However, it can lead to life-threatening complications for both the mother and fetus. In vitro fertilization (IVF) is also associated with an increased probability of adverse outcomes compared to the general population. Timely diagnostics and personalized treatment, taking into account the extremely high risk of complications if PHPT and pregnancy result from IVF, require attention of healthcare professionals and formation of a multidisciplinary team.

Introduction. Hydatidosis is a severe parasitic disease caused by tapeworm Echinococcus granulosus widely spread in some endemic areas all over the world that primarily targets liver, lung, bones, muscles well as pelvis in casuistic cases. Due to the lack of pathognomonic signs as well as low prevalence rate of hydatid cysts in such anatomic sites, a differential diagnosis for relevant gynecological pathologies may be substantially complicated. Compared with common gynecological disease such as uterine fibroids, ovarian cyst and malignancies uterine hydatidosis may be identified only in 0.16 % cases.

Aim: to present a clinical case of uterine hydatid cyst in order to optimize algorithms for differential diagnosis of primary pelvic echinococcosis and gynecological pathology, which is necessary for successfully conducted timely surgical treatment.

Clinical case. In 2023, patient K. complained of dysuric phenomena and a feeling of heaviness in the pelvic area. Based on the anamnesis, clinical picture, laboratory and instrumental research methods, it was decided to perform surgical treatment. The patient underwent laparoscopic hysterectomy and removal of ¾ hydatid cyst. The obtained material was used for histological examination to verify the diagnosis.

Results. Differential diagnosis of uterine echinococcosis is most often carried out with cystic or dysembryogenetic tumors, purulent or tuberculous abscesses, ovarian cysts, ovarian tumors, and uterine fibroids. Features of the MR picture, such as a thick compacted wall, the lack of internal septa, parietal and papillary outgrowths, as well as a solid component, allowed to suspect parasitic genesis of the neoplasm.

Conclusion. While treating patients with cystic neoplasms of the pelvic area referred from endemic areas, echinococcosis should be included in the list of differential diagnostic searches.

The article highlights issues aimed at maternal death in literature. The literary works of Tolstoy, Turgenev, Bunin, Rabelais, Martin, Pushkin, Mann, etc., are discussed.