编号 1 (2025)

This article presents current data from the world literature and more than 20 years of research conducted by the authors into the nature and essence of preeclampsia as a multisystem neuroinflammatory gestational endotheliosis leading to the impairment of the cerebrovascular function and blood-brain barrier (BBB) integrity in both mother and fetus. Neuron-specific proteins (NSPs) as biomarkers of higher structures of the fetal central nervous system, its neuro- and corticogenesis have been shown to play a leading role in determining changes in the fetal brain. Since preeclampsia is a condition observed only in humans, the study of cerebrovascular changes at the level of BBB and the detection of abnormalities of its integrity and permeability in women with preeclampsia represent a challenging task. It is limited not only by clinical trials, but also by the use of imaging techniques and biomarkers in experiment. Neurofilament light chain (NfL), tau protein, neuron-specific enolase (NSE) and S100B are of particular interest. It is necessary to understand how preeclampsia impairs cerebrovascular function and maternal-fetal BBB integrity, causing NSPs to enter the maternal circulation, triggering an immune response with the formation of circulating immune complexes and complement activation through an abnormal pathway, and initiating systemic endothelial dysfunction. The comparative analysis of a large number of clinical observations, as well as data from general and special research, resulted in the development of a new scientific concept for understanding preeclampsia. This concept is based on the key role of NSPs, BBB and hyperactivation of complementary immune defense. The aim of the article is to identify the causal relationship of impaired fetal neurocorticogenesis, NSPs, and increased BBB permeability in the development of preeclampsia.

Conclusion: The proposed concept suggests the revision of therapeutic approaches to the management of patients with preeclampsia, opens the possibility of using innovative approaches to treatment and searching for new therapeutic targets.

Ovarian cancer (OC) is a malignant neoplasm of the female reproductive organs with the highest mortality rate among patients with gynecological cancers. It is mainly detected at late stages and accompanied by ascites. Malignant ascites appears to provide a microenvironment that promotes OC progression. The data of the Russian and foreign studies give insight into numerous components of ascites including populations of tumor and stromal cells circulating in a cell-free environment or in an adhesive state, the proteomic and metabolomic profile of ascites, etc. Mediated effects on these components open new perspectives for more effective therapy of serous OC.

Conclusion: Malignant ascites promotes proliferation, invasion and metastasis of tumor cells through various mechanisms that reduce the efficacy of conventional therapies. Consequently, there is a clear necessity to develop new therapeutic approaches.

Background: Selective fetal growth restriction (sFGR) complicates 10–15% of pregnancies with monochorionic twins and is characterized by discordant fetal growth and a high level of perinatal and neonatal morbidity and mortality. sFGR is classified into three types according to the Doppler pattern of blood flow in the umbilical artery (UA) in growth-restricted twins. Each type is associated with a specific clinical course and perinatal and neonatal outcomes and differs in the degree of uneven placental separation and the functioning of placental-vascular anastomoses.

Objective: To assess the perinatal outcomes of expectant management of monochorionic diamniotic twin pregnancies complicated by sFGR according to the type of UA blood flow disorder in growth-restricted twins.

Materials and methods: A retrospective cohort study was conducted at V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia from January 2017 to January 2024. The course of pregnancy in 128 women with monochorionic diamniotic twin pregnancies complicated by sFGR was analyzed. Group 1 included patients with type I sFGR (n=72), group 2 included patients with type II sFGR (n=37), and group 3 included patients with type III sFGR (n=19).

Results: Perinatal parameters varied depending on the sFGR type. Antenatal fetal growth discordance was significantly different from the first trimester of pregnancy in types I and II sFGR, with the highest discordance observed in group 2. The age at delivery in sFGR type I was greater than that in types II and III (34.2, 31.4 and 31.6 weeks, respectively; p<0.001). Type II sFGR was characterized by the worst outcomes, including the highest discordance in neonatal body weight (42.9%, p<0.001) and the lowest length/height-for-age indicators of growth-restricted children– 988.5 g, 36 cm; body weight: p_1/2<0.001, p_2/3=0.0012, length: p_1/2<0.001, p_2/3=0.049). The proportion of children with growth restriction and severe and moderate birth asphyxia (Apgar score<5) was significantly higher in types II and III sFGR. In our study, the overall survival rate was 92.2% (20 children died, including 6 (2.34%) antenatally and 14 (5.5%) postnatally). Antenatal fetal death with growth restriction occurred in four cases (1.56%) with sFGR types I and II and co-twin death in one patient in group 2. Statistically significant adverse perinatal outcomes (χ²=19.713; p=0.003) were observed for sFGR type II.

Conclusion: The course of multigestational pregnancies complicated by type II sFGR is characterized by the most adverse perinatal outcomes. The classification of sFGR according to the type of UA blood flow disorder should form the basis for an individual management plan for pregnant women, with the level of observation corresponding to the degree of risk for perinatal loss.

Objective: To evaluate the feasibility of using clinical indicators to stratify pregnant women based on preeclampsia severity.

Materials and methods: Ninety-nine pregnant women with moderate preeclampsia were studied, including 48 with progression to severe preeclampsia (group I) and 51 without progression to severe preeclampsia (group II). The control group consisted of 30 healthy women with healthy pregnancies (group III). The examination was performed at hospital admission with moderate preeclampsia and included the progression of preeclampsia to severe preeclampsia. It comprises the determination of the type of 24-hour blood pressure (24h BP) profile, assessment of the frequency of nocturia (NU), periods of gestational sleep apnea, subjective evaluation of sleep characteristics, and the distribution of adipose tissue.

Results: A comparative analysis of high-risk factors for preeclampsia, timing of preeclampsia manifestation, concomitant pregnancy complications, and diagnostic criteria for preeclampsia revealed a lack of predictive capability of the indicators regarding the severity of this pregnancy complication. Analysis of the examination findings using descriptive statistics, univariate and multivariate logistic regression, ROC analysis, and clinical epidemiology tests enabled the development of a prognostic risk stratification model for identifying pregnant women at a high risk of developing severe preeclampsia. The most effective variables were the pathological types of 24-h BP and quantitative assessment of NU (AUC=0.849 –"very good" quality, 95% CI 0.735–0.923, p<0.001). Calculation of the main performance characteristics of clinical epidemiology showed a higher prognostic significance of the model compared to individual clinical criteria (Se=85.3 %, Sp=79.2 %, p<0.001).

Conclusion: A comprehensive clinical approach to predicting severe preeclampsia using the calculation of an integral indicator, has proven its validity and potential for timely diagnosis of early clinical manifestations of the pathological process. This ensures a rational choice of obstetric strategies and addresses the critical issue of preventing life-threatening obstetric complications.

Objective: To determine the clinical and medical history characteristics of pregnant women with different cervical cytology results.

Materials and methods: This retrospective study included 349 patients aged 18–44 years (median=32, Q25–Q75: 29–36). Group 1 included pregnant women without a history of cervical surgery and NILM cytology reports (n=136); group 2 included pregnant women with a history of cervical conization (before pregnancy) for obligate precancer and NILM cytology reports at the time of inclusion in the study (n=67); group 3 included pregnant patients with mild dysplasia (LSIL by cytology, n=63), and group 4 included pregnant patients with severe dysplasia (HSIL according to cytology, n=83). Statistical analysis and data visualization were performed using R version 4.4.0 (build 2024-04-24). The statistical significance of differences between categorical variables was assessed using two-tailed Fisher's exact test, and differences between continuous variables were assessed using the Kruskal-Wallis test. Differences were considered statistically significant at p<0.05.

Results: Pregnant women with HSIL cytology had a nicotine addiction rate of 44.6% (p<0.001), initiated sexual activity at ages 16–18 (p<0.001), a high abortion rate of 59% (p=0.005), and a high birth rate of 83.1% (p=0.016). They also had a high rate of gynecological diseases in general (65.1%, p=0.018) as well as sexually transmitted infections, HIV infections, and viral hepatitis C. Patients with NILM cytology had a higher rate of endometriosis (p=0.018) and ovarian lesions (p=0.037) than those with abnormal cytology. Women with a history of cervical conization were distinguished by the absence of allergic reactions compared to those in the other groups (p<0.001). There were no differences in the rates of extragenital diseases.

Conclusion: Distinct medical history characteristics were observed in patients, depending on the results of the cytological examination. All pregnant women exhibited low adherence to the use of contraceptive methods, a significant number of pregnancy terminations, and high parity.

Objective: To obtain the comprehensive data on the efficacy and safety of dydrogesterone (Duphaston) in adolescent girls with menstrual disorders in routine clinical practice.

Materials and methods: Retrospective analysis of medical records describing the use of dydrogesterone for menstrual disorders in adolescents under the age of 18 who were treated with this medication. The primary outcome was the achievement of menstrual-like reaction after one or three cycles of treatment.

Results: In total, medical charts of 1000 patients were analyzed, including 19 patients who received dydrogesterone treatment on two separate occasions, resulting in a total of 1019 treatment courses described in the report. Mean age was 14.9±1.6 years. The specific indications for Duphaston treatment initiation most commonly reported were as follows: irregular menstrual cycle, dysfunctional uterine bleeding, dysmenorrhea and secondary amenorrhea. Treatment success was achieved in 976 of 1019 cases (95.8%). The success rate did not show significant differences based on age and body mass index.

Conclusion: Dydrogesterone treatment normalized the menstrual cycle in adolescent patients suffering from menstrual bleeding disorders, including dysmenorrhea. Therapy with dydrogesterone demonstrated a favorable safety profile and was well tolerated by patients older than 9 years of age after menarche with menstrual disorders.

Background: Genitourinary syndrome of lactation (GSL) is a new term that represents a complex of symptoms similar to those observed in postmenopausal women. GSL is characterized by atrophic changes in the urogenital tract and imbalance in the vaginal microbiome, which may be caused by decreased estrogen levels during lactation.

Objective: To evaluate the efficacy and tolerability of lyophilized Lactobacillus acidophilus (1×10⁸ CFU) in combination with 0.03 mg estriol in women with GSL.

Materials and methods: The study included 24 women aged 26 to 38 years (mean age: 32±2.6 years) with GSL two to three months following childbirth. Of the participants, 13/24 (54.2%) were primiparous, while 11/24 (45.8%) were multiparous. The spontaneous vaginal delivery rate was 42% (10). All women were recommended to take vaginal lyophilizate of Lactobacillus acidophilus (1×10⁸ CFU) in combination with 0.03 mg estriol: one tablet intravaginally at bedtime daily for 12 days, then one tablet twice a week for up to three months.

Results: Before treatment, the average Vaginal Health Index (VHI) of the women in the study was 19±0.6 and there were no differences between the groups according to the mode of delivery. Following a period of one month during which the vaginal lyophilizate of Lactobacillus acidophilus (1×10⁸ CFU) was administered in combination with 0.03 mg of estriol, a decrease in vaginal pH and an increase in VHI was observed in all subjects participating in the study. These positive dynamics persisted for a further three months in patients undergoing supportive therapy. No side effects or adverse events were noted.

Conclusion: The pilot studies on the use of ultra-low-dose estriol in combination with probiotics in patients with GSL demonstrate the high efficacy and safety of the combination therapy; longer-term use throughout the lactation period is likely to be possible. A particular point of interest for this study was the potential for dyspareunia correction in patients with GSL. The severity of pain during intercourse was assessed using the visual analogue scale (VAS); the women reported a decrease in pain, probably due to improved lubrication after ultralow-dose estriol supplementation.

Background: Vulvar and vaginal dryness accompanied by discomfort is a common problem among women. This problem occurs at various stages of life, including premenopausal, postpartum and postoperative periods. Although hormone therapy is the conventional approach, there is a need for effective and safe non-hormonal alternatives.

Objective: To evaluate the vaginal microbiome, as well as efficacy and safety of Xylalgin vaginal suppositories in women with symptoms of vaginal dryness and related discomfort.

Materials and methods: This was an observational study including 80 female patients who applied Xylalgin once daily in the vagina for 7–10 days. Microbiome was assessed by fluorescence in situ hybridization (FISH).

Results: The suppositories demonstrated a statistically significant reduction in vulvar and vaginal itching and dryness, and an increase in the Vaginal Health Index. The FISH data showed a tendency to normalization of the vaginal microbiome, which was expressed in a decrease in the number of opportunistic microorganisms and an increase in the proportion of lactobacilli that are characteristic of normocenosis. No adverse events associated with the use of suppositories were observed. The effect of the suppositories was rated as completely satisfactory by 84% of the patients.

Conclusion: Xylalgin is a promising non-hormonal treatment for relieving symptoms of vulvar and vaginal dryness and discomfort, helping to improve women’s quality of life. The study emphasizes the importance of finding safe and effective solutions for this common problem.

Pulmonary embolism (PE) is one of the leading causes of maternal mortality worldwide. Treatment of PE in pregnancy and early postpartum is significantly complicated by high risk of bleeding, changes in hemostasis and hemodynamics, and fetal factors. Thrombolysis is the preferable method of reperfusion therapy in life threatening PE in pregnancy, but it is associated with extremely high risk of bleeding in early postpartum period. Therefore, it is necessary to find alternative methods of pulmonary artery reperfusion and stabilization using modern techniques of mechanical circulatory support. The data on the use of endovascular treatment and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in PE in pregnant and postpartum women are extremely limited. This article presents a review of the latest technologies in the treatment of high-risk PE in pregnant women based on the clinical observation of the intensive care unit patients with myocardial infarction at N.I. Pirogov City Clinical Hospital No.1, Moscow City Health Department, Moscow.

Conclusion: An important question that needs to be addressed is when the use of ECMO in patients with PE, even during pregnancy, should be considered. Based on the available experience in the modern world, there are the following main indications: circulatory arrest, refractory cardiogenic obstructive shock, especially when reperfusion therapy is contraindicated or associated with a high risk of bleeding (early after caesarean section, thrombolytic therapy).

Advances in the field of oncology have led to significant improvements in the diagnosis and treatment of malignant tumors, resulting in increased survival rates for cancer patients. More and more women live long enough and reach natural menopause, or experience symptoms of premature ovarian failure due to a side effect of cancer therapy. More than nine million women worldwide are diagnosed with cancer each year, and treatment usually leads to early menopause and associated symptoms. The diagnosis of menopause after cancer can be challenging due to the fact that many women start menstruating within two years of completing chemotherapy. The choice of menopausal hormone therapy (MHT) in cancer survivors depends on the type of tumor. In cases when MHT is contraindicated, non-drug and non-hormonal therapies are available for the management of vasomotor symptoms. It is evident that phytoestrogens alone are not sufficient in managing the vasomotor symptoms associated with menopause. Estrovel is a complex of phytoestrogens, vitamins and minerals. It acts as a selective modulator of estrogen receptors and relieves early manifestations of estrogen deficiency, including hot flushes, emotional lability and instability of blood pressure.

Conclusion: The information presented in this article on the management of menopausal symptoms in patients after cancer of various localizations is intended to assist medical professionals in treating such patients.

Background: The prevalence of preeclampsia ranges from 2 to 24% of all births, eclampsia from 0.03 to 0.1%. These conditions are responsible for the highest number of maternal morbidity and mortality cases. Eclampsia is the most severe, critical form, proceeding with the development of post-eclamptic coma and other serious complications.

Case report: A 32-year-old patient presented at the emergency department of the Lapino Clinical Hospital with complaints of headache and vomiting. On admission, blood pressure (BP) was 170/100 mmHg. Magnesium therapy, nifedipine 10 mg 2 tablets orally, was started in the emergency department. Her condition worsened 1 hour 15 minutes after admission to the intensive care unit: BP level increased to 200/100 mmHg, and the patient experienced clonic convulsions. Due to the development of eclampsia, the decision was made to perform an emergency caesarean section. External drainage of the lateral cerebral ventricle was performed 12 hours after delivery. A range of therapeutic interventions were administered, including magnesium, anticonvulsant, antibacterial, hepatoprotective, antihypertensive, nootropic, neurometabolic, anticoagulant, as well as correction of hypoproteinemia and anemia. The patient was transferred to the neurology department on the 54th day after delivery and discharged home with recommendations on the 69th day. Currently, she undergoes an active rehabilitation process with a very positive dynamic.

Conclusion: The timely diagnosis of eclampsia complications, the management of patients with eclampsia, and the administration of adequate therapy should be carried out in a hospital with multidisciplinary teams, and using a multidisciplinary approach, which allows high rehabilitation results to be achieved.