V.F.Snegirev Archives of Obstetrics and Gynecology
ISSN (print): 2313-8726, ISSN (online): 2687-1386 Founder: Joint Stock Company "Publishing house "Medicina", Limited Liability Company "Eco-Vector" Editor-in-Chief: prof. Elena A. Sosnova, MD, Dr. Sci. (Med.) Frequency / Access: 4 issues per year / Hybrid Included in: Higher Attestation Commission List, RISC
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Snegirev Archives of Obstetricsand Gynecology” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “V. F. Snegirev Archives of Obstetricsand Gynecology” (further-the Journal) in accordance with the conditions stated below. I. 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Correction of vitamin status in pregnant women: current approaches and clinical significance
This systematic review aims to summarize current evidence on vitamin deficiencies in pregnant women, their clinical consequences, and approaches to nutritional status correction during gestation. Given the increasing prevalence of hypovitaminosis among pregnant women, particularly deficiencies of folic acid, vitamin D, and vitamin B12, the clinical importance of early diagnosis and individualized therapy is growing. The article analyzes studies published over the past 5 years by Russian and international authors, including randomized controlled trials, meta-analyses, cohort studies, and international clinical guidelines. Key micronutrients, their effects on the course of pregnancy, maternal and fetal outcomes, and factors contributing to impaired vitamin metabolism, including genetic polymorphisms (MTHFR, VDR, TCN2), were evaluated. The review presents approaches to laboratory diagnosis of vitamin deficiencies, principles of rational dietary therapy, and the use of vitamin–mineral supplements, as well as the potential of personalized nutritional correction. The need for incorporating vitamin status assessment into preconception care and antenatal management algorithms for women at risk is substantiated. The findings of this review emphasize the role of nutritional support as an essential component in the prevention of obstetric and perinatal conditions.
Copyright (c) 2025 Eco-Vector https://eco-vector.com/for_authors.php#07
Evolution of concepts of platinum resistance in ovarian cancer and current therapeutic opportunities
Ovarian cancer remains one of the leading causes of mortality among gynecological cancers. The major challenge in its treatment is the development of resistance to platinum-based agents. Traditionally, platinum sensitivity of the tumor was assessed based on the treatment-free interval. However, with the introduction of targeted and maintenance therapies, such as PARP inhibitors and antiangiogenic drugs, these criteria require reevaluation. Current evidence indicates that platinum resistance arises from complex biological processes involving homologous recombination deficiency, activation of DNA repair pathways, alterations in the tumor microenvironment, increased expression of drug transporters, evasion of apoptosis, as well as the involvement of cancer stem cells and clonal evolution. The elucidation of these mechanisms has provided the basis for new therapeutic strategies. A key focus is on ATR and WEE1 inhibitors, epigenetic agents, antibody–drug conjugates, immunotherapy, and combination approaches that act simultaneously on multiple pathogenic pathways. A promising direction involves integrating molecular profiling and biomarker assessment to select patients most sensitive to specific therapeutic modalities. Thus, the evolving concept of platinum resistance in ovarian cancer reflects a shift from time-based clinical criteria toward molecular and biological stratification. This transition opens new opportunities for personalized treatment, which can enhance not only treatment efficacy but also long-term outcomes for patients with an unfavorable prognosis.
Chronic endometritis as a multifactorial cause of reproductive loss: current diagnostic criteria and therapeutic options
Chronic endometritis is one of the most significant and relevant challenges in reproductive medicine. This disease is associated with reduced pregnancy rates and an increased risk of spontaneous miscarriage and implantation failure in in vitro fertilization. Chronic endometritis is generally asymptomatic, which hiders timely diagnosis and treatment. This review summarizes current knowledge on the pathogenetic mechanisms, diagnostic capabilities, and treatment strategies for chronic endometritis, as well as their impact on reproductive outcomes. The analysis was based on data from 27 publications for 2021–2025 retrieved from international and Russian databases, encompassing meta-analyses, systematic reviews, and original clinical studies. The leading pathogenetic factors of chronic endometritis include microbial dysbiosis characterized by polymicrobial associations, neutrophil hyperactivation with the formation of neutrophil extracellular traps, cytokine imbalance, and activation of the USF2/TREM1 and miR-92b/PTEN signaling pathways. These alterations impair endometrial receptivity and hinder successful embryo implantation. Although a histological examination identifying CD138+ plasma cells remains the diagnostic gold standard, variability in threshold values complicates interpretation. Diagnostic evaluation is further complemented by hysteroscopy and promising noninvasive methods, including artificial intelligence-based analysis of hysteroscopic images and serum biomarker assessment. Antibiotic therapy remains the mainstay of treatment, though its effectiveness is undermined by rising antimicrobial resistance. Modern therapeutic approaches involve the use of recombinant type III collagen and antifibrotic therapy, which improve endometrial structure and receptivity, increasing pregnancy rates up to 73.9%. This review highlights the need for standardization of diagnostic algorithms, integration of molecular technologies, and adoption of combined therapeutic regimens to enhance management efficacy in chronic endometritis and improve reproductive outcomes.
Genetic markers of endometrial hyperplasia: from pathogenesis to personalized therapy
Endometrial hyperplasia, particularly in perimenopause, constitutes a major clinical challenge in gynecology due to its high risk of malignant transformation into endometrial cancer, which is driven by a complex interplay between genetic alterations and hormonal imbalance. Evidence suggests that certain genetic markers (ESR1, C-MYC, PIK3CA, PTENP1, MTHFR, EGFR) contribute to the pathogenesis of endometrial hyperplasia by disrupting the regulation of proliferation, apoptosis, and DNA methylation. ESR1 polymorphisms increase estrogen receptor density, thereby enhancing the proliferative response of the endometrium. C-MYC overexpression correlates with progression to atypical forms, although it is also observed during physiologic regeneration. PIK3CA mutations result in constitutive activation of the PI3K/AKT/mTOR pathway and are associated with therapeutic resistance. Loss of function of the pseudogene PTENP1 disrupts regulation of the tumor suppressor PTEN, thereby promoting uncontrolled cellular proliferation. MTHFR polymorphisms impair DNA methylation and heighten susceptibility to epigenetic dysregulation. EGFR overexpression enhances proliferation through the MAPK/ERK pathway, particularly in obesity. The clinical significance of these markers is often influenced by underlying conditions, and their role remains ambiguous due to population differences and methodological heterogeneity across studies. A promising direction in the management of this condition is the development of integrative prognostic models that combine genetic testing with clinical parameters for risk stratification and early prevention of endometrial cancer.
Copyright (c) 2025 Eco-Vector https://creativecommons.org/licenses/by-nc-nd/4.0
Personalized 3D printed obstetric pessaries
Since its emergence in the 1980s, three-dimensional (3D) printing has become a representative manufacturing assist technology. It was first developed for rapid prototyping and is widely used in a variety of fields. Since the early 2000s, 3D bioprinting using biological materials such as cells and biomolecules has been successfully applied in tissue engineering to directly create living structures. Over the past several decades, advances in three-dimensional (3D) printing technologies and the development of specialized biomaterials have facilitated the precise fabrication of biological components and complex 3D shapes. In obstetrics and gynecology, pessaries are increasingly used for stress urinary incontinence, pelvic organ prolapse, and cervical insufficiency. Commercially available pessaries come in a variety of sizes, following a “one size fits all” approach that fails to take into account the unique anatomical characteristics of each woman. The effectiveness of these pessaries is limited by poor fit and the lack of easy adjustment. The aim of this study was to analyze literature on the feasibility of individualized pessary selection for stress urinary incontinence, рelvic organ prolapse and cervical insufficiency using 3D printing. We analyzed Russian and international publications in the PubMed, ScienceDirect, Elseiver, e-library databases, covering searches from 2015 to 2025.
Perinatal outcomes in pregnant women with COVID-19 at different gestational ages and disease severities
BACKGROUND: Investigation of the impact of gestational age and the severity of Coronavirus Disease 2019 (COVID-19) on pregnancy outcomes is of particular importance in the context of the continuing relevance of this issue, as well as for the development of preventive strategies and therapeutic approaches aimed at reducing adverse maternal and fetal outcomes. AIM: To evaluate perinatal outcomes in pregnant women who developed COVID-19 at different gestational ages and with varying degrees of disease severity. METHODS: Perinatal outcomes were analyzed in pregnant women from three clinical groups: group 1, patients who developed COVID-19 during the first trimester (n = 119); group 2, patients infected during the second trimester (n = 121); group 3, patients infected during the third trimester of pregnancy (n = 120). Each clinical group was further divided into three subgroups according to the severity of COVID-19 (mild, moderate, and severe). Statistical analysis of the clinical data was performed using StatSoft software (Russia). Differences were considered statistically significant at p < 0.05. RESULTS: The analysis showed that severe SARS-CoV-2 infection occurring in the first trimester of gestation contributes to pregnancy termination in more than 50% of clinical cases. At the same time, patients who had mild COVID-19 in early gestation significantly more frequently delivered infants with normal birth weight and favorable early neonatal adaptation compared with those born to mothers with moderate or severe COVID-19. SARS-CoV-2 infection during the second trimester identified pregnant women as a high-risk group for adverse perinatal outcomes, including fetal growth restriction, and increased the likelihood of complicated early neonatal adaptation. In pregnant women who developed COVID-19 during the third trimester, a high risk of acute fetal hypoxia and abdominal delivery was observed, not only for obstetric indications but also due to a more severe COVID-19 course. The higher rate of preterm birth among infants born to mothers with severe COVID-19 during the second and third trimesters was associated with earlier medically indicated delivery and with pathological maternal changes caused by infection-related hypoxia. CONCLUSION: The study demonstrated that the distribution and frequency of perinatal complications depend on both the gestational age and the severity of COVID-19.
Evolution of treatment approaches for cesarean scar pregnancy
BACKGROUND: Cesarean scar pregnancy is a relevant problem in modern obstetrics and gynecology. This condition may lead to life-threatening complications requiring urgent medical intervention. Hysteroscopic resection using the cold loop technique in combination with vacuum aspiration of the gestational sac is an effective and safe surgical method for the treatment of cesarean scar pregnancy. AIM: This study aimed to evaluate treatment approaches for cesarean scar pregnancy and to determine optimal surgical strategies, as well as to analyze morphological findings in surgical specimens obtained from patients with cesarean scar pregnancy. METHODS: The study was conducted at the Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky. Between 2016 and 2025, surgical treatment was performed in 41 patients with cesarean scar pregnancy. Management strategies used in 2016–2019 were compared with those applied over the subsequent 5 years. Clinical characteristics, preoperative ultrasound findings, and surgical treatment methods were analyzed (including laparotomic metroplasty, vacuum aspiration of the gestational sac, hysteroscopic resection using a cold loop, and hysterectomy). RESULTS: More than half of the examined women had a history of more than two cesarean deliveries performed with cervical dilation greater than 5 cm. Ultrasound examination demonstrated localization of the gestational sac within the scar area in all patients (COS-1 sign). Signs of chorionic invasion were identified in 22.7% of cases. Both organ-preserving and radical treatment approaches were applied. Over the past five years, a trend toward increased use of minimally invasive surgical techniques has been observed at the institute, resulting in reduced duration of hospitalization and postoperative rehabilitation. The complex of morphological features identified within scar niches containing ectopic pregnancies was characteristic of placenta accreta spectrum disorders (placenta creta); however, given the early gestational age and absence of a fully formed placenta, this condition may be referred to as chorionic invasion. CONCLUSION: Cesarean scar pregnancy is a rare but extremely dangerous complication that may result in uterine rupture, massive hemorrhage, and maternal mortality. Minimally invasive organ-preserving techniques—vacuum aspiration and hysteroscopic resection using the cold loop technique—represent the optimal treatment strategy. In cases of pronounced destructive changes of the uterine wall, metroplasty is justified.
A contemporary perspective on predicting early postpartum hemorrhage: risk factor stratification for developing a predictive scoring system
BACKGROUND: Early postpartum hemorrhage is a life-threatening complication that requires emergency care and a multidisciplinary approach. In addition to the main etiological causes of hemorrhage (the 4T concept), the influence of other factors has been identified, the study of which allows for the development of predictive scoring systems, differentiated preventive strategies, and minimization of the risk of early postpartum hemorrhage. AIM: To identify factors influencing the development of early postpartum hemorrhage, stratify the obtained data, and develop a risk assessment scoring system for this complication. METHODS: A retrospective case–control study was conducted. The main group (n = 219) included women whose deliveries were complicated by early postpartum hemorrhage, whereas the control group (n = 219) consisted of women without postpartum hemorrhage. A list of potential factors determining the risk of postpartum hemorrhage (comprising 38 parameters in total) was compiled. The effect of each parameter on hemorrhage risk was assessed using odds ratios with 95% confidence intervals, p values for statistical significance, and the Student t test. Logistic regression analysis was used to stratify the impact of predictors on the development of early postpartum hemorrhage. RESULTS: Statistical analysis identified 25 factors that significantly increased the risk of postpartum hemorrhage. Oligohydramnios at the time of hospitalization increased the risk of postpartum hemorrhage by 1.6 times, polyhydramnios by 1.7 times, premature rupture of membranes by 1.7 times, class I obesity by 1.9 times, class II obesity by 2.2 times, gestational diabetes mellitus by 2.0 times, and the presence of a uterine scar after cesarean delivery or myomectomy by 2.2 times. Using logistic regression analysis and odds ratio data, these predictors were successfully stratified and integrated into a unified scoring system for assessing the risk of early postpartum hemorrhage. CONCLUSION: The proposed risk stratification score for postpartum hemorrhage serves as a clinical decision support tool in urgent settings, enabling rapid and objective assessment of early postpartum hemorrhage risk, timely implementation of preventive measures, and improvement of maternal outcomes.
Effect of menopausal hormone therapy and phytoestrogens on the oxidant/antioxidant profile of blood plasma in peri- and postmenopausal women
BACKGROUND: One of the most significant consequences of altered estrogen levels during the peri- and postmenopausal periods is the development of oxidative stress, which plays a key role in the pathogenesis of age-associated diseases. At present, the effects of menopausal hormone therapy and phytoestrogen therapy on antioxidant homeostasis are actively discussed. Available data are inconsistent, indicating that estrogen may exert both pro-oxidant and antioxidant effects, which makes this issue particularly relevant. AIM: To investigate the effects of menopausal hormone therapy and phytoestrogens (soy isoflavones and resveratrol) on the oxidant/antioxidant profile of blood plasma in peri- and postmenopausal women. METHODS: The study included 92 patients with climacteric syndrome who were divided into four groups: group 1, menopausal hormone therapy (n = 25); group 2, soy isoflavone therapy (n = 23); group 3, resveratrol therapy (n = 24); and a control group, no drug therapy (n = 20). The severity of climacteric syndrome was assessed using questionnaire-based scales before treatment and after 3 months. The antioxidant profile of blood plasma was analyzed using kinetic luminol-enhanced chemiluminescence. RESULTS: The most pronounced reduction in climacteric syndrome severity was observed with menopausal hormone therapy using estradiol and dydrogesterone combination therapy. A positive clinical trend was also noted in the resveratrol group. Soy isoflavone therapy did not have a significant effect on the course of climacteric syndrome. Neither menopausal hormone therapy nor soy isoflavone therapy influenced antioxidant profile parameters. Resveratrol exerted a favorable effect on the thiol antioxidant system, and a correlation was identified between the status of the thiol antioxidant system and the severity of climacteric symptoms. CONCLUSION: The findings demonstrate high clinical relevance and indicate the safety of menopausal hormone therapy and resveratrol with respect to the oxidant/antioxidant homeostasis of the blood, as well as their pronounced clinical efficacy. Further studies are needed to evaluate long-term outcomes.
This article presents a review of the etiology, pathogenesis, clinical manifestations, and diagnostic approaches to aortic coarctation, which accounts for approximately 6%–7% of all congenital heart defects and occurs in pregnancy with a frequency of about 1 case per 4500 deliveries. For a long time, pregnancy in women with aortic coarctation was considered extremely high risk, and pregnancy termination was often recommended. Pregnancy in women with unrepaired aortic coarctation is frequently associated with various complications, including uncontrolled hypertension, preeclampsia, hypertensive crisis, congestive heart failure, stroke, and aortic rupture or dissection. At present, there are no clear guidelines or a unified approach to the management of pregnancy in women with aortic coarctation. Recent studies indicate that, with appropriate management, pregnancy may proceed without serious complications. The main reasons for hospitalization during pregnancy in these patients include heart failure, uncontrolled hypertension, and supraventricular arrhythmias. Therefore, strict blood pressure control appears to be a key component in the management of pregnant women with this condition. A clinical case describing pregnancy management and delivery in a patient with newly diagnosed aortic coarctation is also presented.
Port-site hernia after repeat staging procedures in a patient with a borderline ovarian tumor: a case report
Laparoscopic surgery has become the gold standard in gynecology owing to its minimal invasiveness and low complication rate. However, its widespread use makes awareness of rare but potentially serious risks, such as port-site hernia, critically important. This complication, reported in 0.34%–5.40% of cases, may develop even with flawless surgical technique and no apparent predisposing factors. We present a rare case involving a 47-year-old patient. After an initial laparoscopic procedure for an ovarian cyst, histological examination revealed a serous borderline ovarian tumor. The patient subsequently underwent a repeat laparoscopy with hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. No intraoperative complications occurred; ports were inserted in the standard manner, and the resected tissue was removed transvaginally in an endobag. Nevertheless, in the postoperative period, the patient developed dyspeptic symptoms refractory to conservative therapy. During follow-up, progressive partial high small-bowel obstruction was identified. On postoperative day 12, laparotomy revealed a loop of small intestine incarcerated in a port-site defect of the anterior abdominal wall. Hernioplasty was performed. Analysis of the case suggests that despite the absence of classical risk factors (obesity, diabetes), enlargement of the trocar port during extraction of a bulky specimen in the first operation was likely the predisposing event. This observation underscores that the risk of port-site hernia persists even when technique is optimal. Nonspecific symptoms such as dyspepsia may mask a life-threatening condition—intestinal obstruction. Careful fascial closure of trocar-site wounds, particularly in middle-aged and older patients, remains the key preventive measure of such complications.
Temporary balloon occlusion of the common iliac arteries during hysterectomy for giant cervical fibroid
Surgical treatment of giant uterine fibroids with cervical localization represents one of the most challenging tasks in operative gynecology. The main difficulties are associated with distorted pelvic anatomy, limited space for manipulations, and a high risk of massive intraoperative bleeding, which necessitates the use of modern blood loss control techniques. Among these approaches, temporary endovascular balloon occlusion of the major pelvic vessels has proven to be a highly effective technique for minimizing hemorrhagic risk and ensuring the safety of radical surgery. This article presents a clinical case describing successful treatment of a 56-year-old woman with a giant uterine fibroid of a 20-week gestational size, cervical localization of the lesion, and severe comorbidities. The patient’s medical history was complicated by an episode of massive uterine bleeding in February 2024 that required emergency uterine artery embolization. Considering the patient’s age, fibroid size, complex localization, and comorbidity burden, a two-stage treatment strategy was chosen. During the first stage, preoperative preparation with a gonadotropin-releasing hormone agonist was carried out for three months to reduce fibroid volume. At the second stage, panhysterectomy was performed with prior temporary balloon occlusion of the common iliac arteries. With temporary vascular occlusion, hysterectomy with bilateral adnexectomy was successfully completed. A critical outcome was minimal intraoperative blood loss of only 200 mL, which did not require blood transfusion. The arterial occlusion lasted 40 minutes, which prevented ischemic complications. This clinical case clearly demonstrates the effectiveness of temporary balloon occlusion of the major pelvic vessels as a key method for preventing massive intraoperative blood loss during hysterectomy for giant uterine fibroids with complex localization. The technique appears promising and may be considered a standard of care in similar clinical situations.