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The paper discusses the representation of pregnancy in the customs and beliefs of a region in Serbia known as Rađevina. The research was aimed at recording and preserving the customs and lexis regarding pregnancy in this part of Serbia. We obtained the lexis through topic-guided conversations with the informants. The article is divided into several sections: on pregnancy before pregnancy, prohibitions during pregnancy and consequences if they are not observed, revealing the baby's gender, conclusion and glossary. Rađevina used to have a system of regulations that the pregnant woman had to adhere to. Special attention was paid to the behaviour of the pregnant woman herself. It was in larger part regulated by means of numerous prohibitions and limitations. Most of those prohibitions were based on the assumption of a magical relation of the future mother and the foetus in her womb. It is interesting to note that some prohibitions were observed before pregnancy itself, during the wedding ritual. In this period, the community tended to facilitate the bride's conception of a fair, healthy male child. During pregnancy itself the pregnant woman used certain objects to protect herself from evil and negative influences of her surroundings. The largest number of prohibitions during pregnancy were implemented so that a healthy, but also fair child should be born. Apart from that, the prohibitions were intended to influence the child's longevity. The section on pregnancy before pregnancy lists the techniques applied in the wedding ritual which influenced the bride's fertility with imitative magic. We also shed some light on the traditional revealing of the future child's gender, and the paper is ends with a glossary. [ABSTRACT FROM AUTHOR]

Objective: to increase the safety of a patients with cardiovascular pathology during the implementation of their reproductive function, by presenting a modern strategy of medical support for such women based on the assessment of the maternal and perinatal risks. Cardiac pathology is the leading cause of morbidity in pregnant women and an indirect cause of maternal mortality. In recent decades, the focus on the problem of safety of pregnant women with the pathology has been steadily increasing. Stratification of patients by cardiovascular risk (CVR) consists of assessing the functional capacity of the patient, cardiac medications needs, history of previous cardiac events, diagnosis of structural, anatomical, and physiological changes and parameters of heart remodeling, and, if necessary, genetic counseling. An important point is to inform the patient about the potential risks and make a consensus decision with her about the possibility of safe implementation of her reproductive function. The authors of the paper analyze the CVR assessment scales used in leading medical practices and the national health care system as well, discuss current clinical guidelines for risk stratification and registered strategies for pregnancy and delivery management depending on the class of CVR in such patients. This paper presents the basic principles of medical support for women of reproductive age with pathology of the heart and great vessels in the form of an algorithm developed by the National pregnancy heart team. Determination of the degree of risk allows to prepare a woman with cardiovascular pathology for the pregnancy and delivery (medical correction or preventive cardiac surgery). Research on the identification and categorization of maternal and perinatal CVR factors and stratification of pregnant women by risk classes are extremely relevant and continue in the framework of the international study ROPAC (Registry Of Pregnancy And Cardiac disease). Ukrainian multidisciplinary team (on the base of two academic State Institutions – “National Amosov Institute of Cardiovascular Surgery” and “Institute of Pediatrics, Obstetrics and Gynecology named after acad. O.M. Lukianova”) takes an active part in this international collaboration.

Pregnancy is a period of high risk for all patients with aortic pathology. Heritable thoracic aortic diseases (HTAD) refer to aortopathies with a high risk of formation and dissection of thoracic aortic aneurysm (TAA). HTAD are caused by a mutation of a certain gene. This paper reviews current perceptions of manifestations of rare hereditary diseases of the thoracic aorta during pregnancy and general recommendations for the medical care of these patients. To date, 16 genes (or loci of unidentified genes) are known to be associated with the development of thoracic aortic aneurysm, and since many families with a history of TAA (about 70%) have no pathogenic changes in any of these 16 genes, additional genes associated with HTAD have not yet been identified. In this paper, HTAD are considered which occur (or are identified) quite rare but provide a significant risk for patients, which is significantly increased during pregnancy (multisystemic smooth muscle dysfunction syndrome, Meester Lois syndrome, LOX and PRKG1 genes mutations, vascular Ehlers-Danlos syndrome, mutations in TGFB2, TGFBR1, TGFBR2, SMAD3 loci, Loeys-Dietz syndrome). The article analyzes the frequency of occurrence of the most threatening complication of HTAD – acute aortic dissection – in various syndromes, defines general recommendations for the examination of patients with HTAD, recommendations for conservative treatment of these patients. Recommendations for the patients (especially fertility women) concerning the preventive cardiac surgery are also summarized in the paper. These principles of pregravidary preparation and multidisciplinary medical support during pregnancy are the most effective prophylactic measures for major cardiac events and maternal death. Pregnancy heart team that has been working in Ukraine since 2013 does all its best to organize medical support for every pregnant woman with suspected HTAD. In this context, it is very important to collaborate with general practitioners and genetics to “catch” such patients before they become pregnant or in very early terms. Individualized plan of pregravidary preparation and medical care during pregnancy and delivery should be developed by a multidisciplinary team.

Spontaneous preterm birth is one of the most pressing issues in obstetrics, as it remains one of the leading causes of newborn morbidity and mortality. Pending issues of aetiology, pathogenesis, and absence of medicinal products indicated for the treatment of spontaneous preterm labour pose a challenge for rational pharmacotherapy. The paper presents the results of a scientific literature review on the problem of rational pharmacotherapy of spontaneous preterm labour using tocolytic drugs — calcium channel blockers, cyclooxygenase inhibitors. The paper summarises specific pharmacokinetic parameters of these drugs during pregnancy. It discusses pharmacogenetic aspects of using tocolytic drugs in pregnant women and their potential clinical effects. It was demonstrated that women with threatened miscarriage had high interindividual variability in nifedipine plasma concentrations depending on CYP3A5 genotype. It was shown that certain genetic polymorphisms of CYP2C9 may lead to an increased metabolic rate and an increase in indomethacin clearance resulting in the reduction of its efficacy. Yet, there is minimal research regarding this issue. Therefore, further research is needed to assess the impact of CYP3A5 and CYP2C9 genotypes on the efficacy and safety of nifedipine and indomethacin used as tocolytic drugs in obstetrics.

Antenatal and postnatal processes and services is a component of Hospital Management Systems that has been given very little attention. Most healthcare institution carries out the antenatal and postnatal processes manually and keeps records of the whole processes on paper. In most cases in most hospital, records kept on paper and files get missing or misplaced leading to the loss of important records of clients which would have been very helpful for future pregnancies and clinical diagnosis. Report generation and statistical figures are difficult to generate with the manual based system. Data errors, security, and privacy are another problems associated with the manual system. In this paper, the antenatal and postnatal services were incorporated into the Hospital Management System of Usmanu Danfodiyo University, Sokoto with a view to reducing the issues and inconsistencies encountered with the manual procedure. Dreamweaver, PHP, CSS, JavaScript, Ajax, HTML and MySQL are the technological tools used to automate the incorporated antenatal and postnatal services in the system. The usefulness of the proposed system was evaluated using the System Usability Scale (SUS) questionnaire and some clinical users. The experimental evaluation shows that the developed system is beneficial to the clinic and the general public based on the result obtained in this study. The results also demonstrated that the developed system can fit into the antenatal and postnatal routine of many hospitals with little or no modification.

This paper presents the research of the hemostatic whole blood's potential of healthy and pregnant women (39-40 weeks) according to the clinical data using the "global" low-frequency piezothromboelastography. Three types of the hemostatic potential (hypo-, normal- and hipercoagulative) are exposed in the status of the physiological optimum. It is shown that when forming the syndrome of the general circulator adaptation of the organism to the pregnancy and the childbirth is accompanied by intensification of thrombin activity and compensatory strengthening of total antihaemostatic activity. It is shown that only the timely research of the whole blood with aliquoties of endotelium (a number of them effects in the bounded time duration) producers tests, blood corpuscle and hemostasis factors, can provide the unbiased information about "time sample" of the hemostatic potential status.

This paper provides a literature review on premature separation of the normally implanted placenta (PSNIP), also known as placental abruption or abruptio placentae, a severe pregnancy and childbirth complication. Acute placental abruption is an obstetric complication that causes massive internal bleeding, leading to intrauterine fetal death. The bleeding can also contribute to multiple organ failure, which is responsible for the high rates of maternal and perinatal morbidity and mortality associated with this obstetric complication. Researching various aspects of complications and preventing the occurrence of PSNIP is of great medical and social significance. PubMed and Google Scholar electronic databases were used to analyze placental abruption studies, resulting in over 3,000 sources. After considering keywords, 60 sources were selected and included in the study.

Introduction and purpose. Preserving fertility is crucial for cancer patients, aligning with advancements in oncology. As survival rates improve, addressing treatment-related late effects gains importance. Many young patients, aware of therapy toxicity, consider future conception chances, impacting treatment decisions. With a trend toward delayed childbirth and a growing population facing unplanned family planning disruptions, the demand for fertility preservation is expected to rise. This paper provides a brief review of available methods for preserving fertility in cancer patients. State of knowledge. Freezing semen in liquid nitrogen vapor is a standard method for preserving reproductive potential in male cancer patients. Shielding during total-body radiation limits testicular volume reduction, indicating less damage to the germinal epithelium. Hormone suppression treatments are not protective in male cancer patients. Oocyte and embryo cryopreservation are considered secure methods before anticancer treatments, with oocyte cryopreservation being preferred for post-pubertal women. Ovarian tissue cryopreservation remains an alternative method without preliminary treatment, suitable when time is insufficient for ovarian stimulation. Ovarian transposition beyond the intended radiation area, performed laparoscopically, can retain ovarian function. GnRH agonist administration before and during chemotherapy aims to minimize the likelihood of premature ovarian insufficiency. Summary. Advancements in fertility preservation for cancer patients, ranging from traditional cryopreservation to innovative methods like ovarian tissue preservation, highlight a commitment to empowering individuals facing cancer diagnoses. Ongoing research expands possibilities, ensuring a diverse range of strategies that offer tangible and hopeful prospects at the intersection of cancer and reproductive health.

The paper is devoted to studying the mechanisms of combined immunosuppression in pregnant women with influenza infection to develop arrangements for controlling these processes and for decreasing mortality from this infection. In this connection the author is dwelling on the following problems: -- How are the fetus immune privilege and tolerance development provided? -- What mechanisms do underlie the functional immunosuppresion under pregnancy? - Why are the infections especially dangerous for pregnant women? -- Is there the code of the immune system control, and do viruses use this code? The paper deals with the problem of influence of endogenic viruses, which have penetrated the human genome more than 25 million years ago, on the great number of risks of development of various kinds of human pathologies: from infertility to pregnancy diseases; from development of malignant tumors to system pathology and autoimmune diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Currently, no systematic data are available on fetal radiation exposure as a result of radiographic studies during pregnancy. Consequently, there are no approved methods of its calculation that can be used in clinical practice. It is especially relevant for computed tomography scans as it is a widely used and highly informative method of diagnostic imaging associated with high exposure levels. AIM: to systematize currently available data on radiation dose absorbed by the fetus from computed tomography scans in pregnant women. MATERIALS AND METHODS: The search for publications in Russian and English was conducted in PubMed/Medline, Google Scholar and еLibrary. The final analysis included 12 papers including 8 studies using human body phantoms, 3 retrospective studies and one prospective clinical study. RESULTS: Abdominal and pelvic computed tomography scans as well as whole-body scans were found to be associated with the highest fetal radiation exposure. However, in none of the publications the fetal exposure limit was exceeded. CONCLUSION: Clinically indicated non-contrast-enhanced computed tomography scans in pregnant women are not likely to be associated with the fetal absorbed doses that exceed the limit of 100 mGy regardless of the scanned area. However, this limit might be exceeded in case of performing multiple studies or if multiphase abdominal or pelvic computed tomography scans, or whole-body computed tomography scans are performed in patients with multiple trauma. In these cases, a decision regarding the need for these investigations should be made by a multi-disciplinary team (including radiation safety specialists, diagnostic radiologists and clinicians) based on the results of additional risk assessment.

The herpes virus is an urgent problem, particularly in the obstetrician-gynecologist practice. The main objective of this paper was to review and analyze current literature data on the effect of the herpes virus on the mother and child during gestation. A variation of the diagnosis of prenatal herpes infection was reviewed. The treatment and prevention methods of the herpes simplex virus for a pregnant woman are addressed. It was shown that preventive antihomotoxic therapy had a fetoprotective effect, significantly reducing the risk of prenatal infection. Introducing preconception preparation for a wide population cohort, including the suppression of viruses in the mother's body, is relevant. The following methodology was used during work on the article: selection of publications using modern information databases, analysis of the obtained information, systematization of materials, and presentation of conclusions. An electronic search was conducted using publications identified in the following databases: eLIBRARY.RU, Google Scholar, and PubMed.

The data presented in this paper shows the role of HLA genes and their products HLA-antigens in reproduction. The study is concentrated on new ideas of the role and mechanisms underlyin the functions of both classical and newly determined HLA genes and their products: New data and hypotheses on HLA-molecules' role in "physiological" pregnancy are discussed.

The manner in which multifunctional steroid hormones realize their separate biological functions in mammal organisms is considered. This study is carried out on the basis of a systematic set of progesterone analogues, which we developed and described in part I of the review. This set has for the first time enabled the use of compounds of this type for studying the pathways and realization mechanisms of separate biological functions of steroid hormones. The interaction of pregna-D'-pentaranes with the classical progesterone receptor, their independent influence on the myometrium and ovogenesis, and some nonclassical effects are described. A scheme of realization is suggested for the biological functions already known, newly discovered, and presumed by us that, during pregnancy, are fulfilled in mammal organisms by progesterone and its nearest metabolite, dihydroprogesterone. The English version of the paper: Russian Journal of Bioorganic Chemistry, 2005, vol. 31, no. 3; see also http://www.maik.ru.

Summarized in the paper is the experience of defining the clinical significance of examination of hemodynamics of mother and fetus in physiological and complicated pregnancy. The normative parameters of blood circulation in the vessels of mother and their central hemodynamics are described. An interrelation between the changes of central hemodynamics of mother and fetus are shown in the development of gestosis and placental insufficiency. The orientation, succession and changes of blood circulation in the arteries and venous vessels of fetus are demonstrated in chromosomal anomalies, congenital malformation, premature pregnancy, gestosis, fetoplacental insufficiency and postmaturity. It was proven as prognostically valuable to study the parameters of blood circulation of mother and fetus not only in diagnostically complicated pregnancy but also in evaluating the therapy efficiency, as well as in choosing a method and time for delivery and in prognosticating a perinatal outcome.

This review discusses some aspects of the most common complication of the early gestational period – toxicosis. Vomiting of pregnant women (VP) is one of the frequent manifestations of early toxicosis. This disorder affects the quality of life of a pregnant woman, causes exhaustion, and contributes to the disruption of homeostasis, weakness, and dysfunction of various organs and systems. In addition, it may lead to miscarriage, placental insufficiency, insufficient weight gain during gestation, various perinatal pathologies in children, and other complications. Therefore, VP despite numerous studies conducted throughout the world, remains one of the urgent problems of obstetrics, the solution of which requires sufficient evidence-based research. Papers on various aspects of VP from the PubMed and Google Scholar electronic databases were analyzed. More than 500 sources were found, of which 50 were selected and included in the review, based on the selected keywords.

Introduction and purpose: Inositol exists in the form of nine isomers, two of which are dominant - myo-inositol (MI) and D-chiro-inositol (DCI). It is a naturally occuring sugar involved in many biological pathways. Due to its insulin-sensitizing, anti-inflammatory and antioxidant properties, inositol has been suggested as a novel treatment agent in prevention and treatment of reproductive disorders. The paper presents currently available data regarding the impact of oral supplementation of inositol for fertility of women and men, reproductive outcomes among subfertile women with polycystic ovarian syndrome (PCOS) and its effectiveness on preventing and treating gestational diabetes mellitus (GDM). Material and methods of research: The search was conducted using PubMed and Google Scholarship databases available to November 2023. Results: Although the evidence is still insufficient, it is suggested that inositol may be beneficial for subfertile women, also those undergoing assisted reproductive techniques and in vitro fertilization. Moreover inositol can positively influence sperm quality. Myoinositol supplementation was also effective and safe for pregnant women with GDM and their children. In these women lower HOMA-IR (Homeostatic Model Assessment – Insulin Resistance) and reduction of fetal macrosomia were observed. Myoinositol also seems to be favorable for overweight or obese women in GDM prevention and treatment. Current findings indicate the positive impact for hormonal changes and restoration in menstrual cyclicity in women with PCOS, improving reproductive disorders in these patients. Conclusions: Overall, although findings are encouraging, further trials for this promising intervention are still required to support oral supplementation of inositol.

This paper is the first in a series devoted to the investigation of the possible effect of maternal genotype on the levels of fetal alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) entering maternal blood. We studied the possible association between the maternal haptoglobin system and levels of maternal AFP and HCG, which are markers of fetal pathology. Haptoglobin types were determined in groups of pregnant women with different levels of serum markers. Distribution of haptoglobin types differed from the theoretically expected in one out of five groups tested. In the group with low AFP level, a significant decrease in frequency of the Hp*2 allele was found. A statistically significant decrease of the mean haptoglobin concentration in the group with low levels of AFP and elevated levels of HCG was observed. A reduction in serum haptoglobin concentration was shown to be accompanied by a decrease of serum iron concentration. The possible mechanism underlying the influence of maternal genotype on the levels of AFP and HCG in maternal blood are discussed.

The paper reports the major clinical situations associated with thrombocytopenia in pregnancy. The diagnostic criteria of the most frequent disorders associated with thrombocytopenia that occur during gestation are provided. The issues related to differential diagnosis of thrombocytopenia in pregnancy are discussed.

The nutritionists from the Research Institute for Nutrition at the Russian Academy of Medical Sciences and from the firm "Nutritec" have developed a dry milk product Femilac to correct diet of pregnant and breast-feeding women. The paper provides data on its chemical composition and results of its clinical trial.

This paper discusses the evaluation of intracardiac fetal hemodynamics using Doppler cardiography. Reference values have been obtained for transvalvular blood flow for atrioventricular valves and valves of major fetal cardiac arteries. Hemodynamic fetal patterns and their normal changes in third-trimester uncomplicated pregnancy are demonstrated.

The paper presents findings on weekly weight gain in pregnant women as related to constitutional make-ups. Normal and apparently normal pregnant women who were followed up at an antenatal clinic from 7-8 to 40-41 week's gestation have been assigned at the beginning of pregnancy to three weight groups: normal body weight, excessive body weight due to increased fat deposition and deficient body weight. Anthropometric measurements at 7-8, 25-26 and 36-37 weeks showed that weight gain and fat accretion were highest in pregnancies with an initial deficient body weight and lowest in pregnant women with adiposity. Correlation analysis suggested that there was a relationship between the maternal body weight, gestational weight gain and neonatal birthweights. Since women with initial deficient body weights have a wider range of weight gain, as compared with other somatic types, dietary restriction counselling should be cautious and adequate.

Introduction and purpose: The COVID-19 pandemic has significantly affected the health, life and quality of life of many people around the world. It caused huge changes in the daily functioning of entire societies. Pregnant women are a unique group of people who are particularly at risk. They are accompanied by fear for their health, but also fear of the impact of the disease on their offspring. The pandemic has also caused new challenges for mothers-to-be that have not occurred so far. In this paper, we would like to present the current state of knowledge on the impact of SARS-CoV-2 infection on the risk of developing pre-eclampsia. State of knowledge: We analyzed studies showing the impact of COVID-19 infection on the health of pregnant women, especially on the risk of developing pre-eclampsia. Data from many studies are contradictory. Some studies do not indicate a significant impact of coronavirus infection on the development of pre-eclampsia. Some of them confirm a higher incidence of pre-eclampsia in pregnant women with confirmed COVID-19 infection. Conclusions: Despite the experience gained, there are still many unknowns. Thanks to research, we have more and more knowledge about the course of COVID-19 in pregnant women and its impact on their lives. Many observations are still needed to formulate clear conclusions about the impact of COVID-19 on the risk of developing pre-eclampsia. It is also necessary to continue to educate women, encourage compliance with the recommendations of doctors and the World Health Organization to prevent the spread of coronavirus.

The paper addresses the problem of female corporality in connection with the realization of reproductive function. The paper provides a brief description of this phenomenon at different stages of the reproductive cycle: pregnancy, childbirth and breast-feeding.

Erythema nodosum is the most common form of panniculitis in the paediatric population. It is manifested by painful tumours in shades of red within the subcutaneous tissue, most often within the lower legs. Mild, non-specific systemic symptoms may occur. The course of erythema nodosum is associated primarily with local pain, sometimes implying motor disorders. Erythema nodosum may be primary or secondary as a manifestation of a systemic disease, medication or pregnancy. Although the course is often self-limiting, detecting erythema nodosum requires a systematised diagnosis of potential causative diseases. A detailed medical history and physical examination are vital in this process. Treatment of erythema nodosum most often consists of administering analgesics and anti-inflammatory drugs. Proper causal treatment of the primary disease is more important. The paper presents a case of a teenage girl with an intense course of erythema nodosum, in whom two probable causes of its occurrence were found.

Lung ultrasound has been recognized as a valid imaging method for diagnosing and monitoring COVID-19 pneumonia in pregnant women. The present review aimed to summarize the main findings reported in the literature and international guidelines on the role of lung ultrasound in the care of pregnant women affected by COVID-19. A search strategy was developed and applied to PubMed, Scopus, Web of Science and EMBASE to identify previous papers reporting the utility of ultrasound in diagnosing and monitoring COVID-19 pneumonia. The search retrieved 369 articles and 23 of these were selected for analysis. The articles mainly focused on the definition of the procedure, development of training programs for obstetricians managing pregnant women with suspicion of COVID-19 and definition of scoring systems. The clinical applications of lung ultrasound in this setting have also been described. This review could encourage obstetricians to learn lung ultrasound to use during critical events like a pandemic.

In the modern world, myopia continues to be one of the most common refractive errors and is considered a socially signifi cant problem, since it is a common cause of decreased vision. In connection with the growth of myopia, the risk of developing complications in the fundus increases, leading to the development of degenerative changes in the retina and an irreversible decrease in visual functions in young and middle-aged people. One of these complications is myopic choroidal neovascularization, which leads to a progressive, irreversible decrease in visual acuity and poor prognosis, and the process is often bilateral in nature. The tactics of managing patients with such complications has been determined: antiangiogenic therapy is used – intravitreal therapy with anti-VEGF drugs, which is currently the fi rst choice therapy for this pathology. But in some cases, antiangiogenic therapy is contraindicated, and the question arises about the tactics of managing such patients. The aim: to study treatment options for myopic choroidal neovascularization in patients with myopia in different situations.Material and methods. The paper presents two clinical observations of patients with mChNV, considers the tactics of their management. The patients underwent standard ophthalmological examination, optical coherence tomography (OCT) and OCT-Angio (OPTOPOL Technology, Poland).Conclusions. Women with myopia planning pregnancy need a thorough examination not only by a clinician, but also by an ophthalmologist, since it is necessary to take into account not only the degree of myopia and choose the optimal delivery method, but also to study the state of the retina for the timely diagnosis of degenerative changes in the fundus.

Cytomegalovirus is one of the most widespread DNA viruses, with 90% of women of childbearing age in Poland infected with it. Infection poses a risk to the mother as well as the fetus, as the virus can cross the placenta and damage the fetus. The purpose of this paper is to review scientific publications from 2017-2022, which describe the course of cytomegalovirus infection in pregnant women, the risks to the mother and fetus associated with the infection, methods of diagnosing the infection in the pregnant woman and the fetus, as well as treatment of cytomegalovirus infection and directions for vaccine research. The most common complications of congenital cytomegalovirus infection include hearing loss, mental developmental delays and miscarriage. The infection can be detected in the pregnant woman by immunological testing, while polymerase chain reaction is used in the fetus and newborn. Early detection of infection in a pregnant woman allows the implementation of treatment which includes ganciclovir, valganciclovir, acyclovir and valacyclovir. A vaccine against cytomegalovirus has not been developed. Particularly important in the prevention of infection is to conduct educational activities regarding the routes of transmission of the virus and the consequences of congenital infection for the fetus. Cytomegalovirus infections among pregnant women. It is important to monitor fetal development and possibly diagnose for congenital CMV infection in case of abnormalities, and the best diagnostic method is polymerase chain reaction testing. For the treatment of congenital CMV infection, acyclovir and valacyclovir are preferred, and therapy should be implemented for specific indications. Attention should be paid to educating women about infections caused by cytomegalovirus.

Along with the increasing number of reported cases, multiple sclerosis, one of the main causes of disability among young adults, is nowadays an increasingly common health problem. Considering the fact that it occurs mainly between 20 and 40 years and affects women more often, the question of the impact of the disease on pregnancy becomes obvious. In view of the wide selection of drugs for various purposes and often highly individualized forms of therapy, it seems also important to determine the safety profile of these agents in relation to the health of the pregnant woman and the fetus. All of this is a significant challenge for neurologists and obstetricians and is the subject of many research and studies. The awareness of society, especially women, in the face of the growing problem seems to be equally important. This paper summarizes the current state of knowledge on these issues.

Here we summarize uptodate data on the influence of the most significant micro, macroelements, and vitamins, such as magnesium, vitamin D, iron, and folic acid, on the course of pregnancy and childbirth in obese women. The paper considers both domestic and foreign recommendations for correcting nutritional deficiencies to prevent the development of complications from the pregravid stage to the end of lactation. Nowadays, the deficiency of micro-, macroelements and vitamins is an extremely urgent problem, especially in a group of special risk, i.e. overweight and obese women, whose number is steadily growing simultaneously with an increase of the number of pregnant women of 35+ years of age. It is important to consider a woman's body mass index to prescribe the minimum effective dose of the necessary drugs. Timely preventive personalized correction of the micronutrient state can reduce the risks of such major obstetric syndromes as preeclampsia, premature birth, fetal growth retardation, miscarriage, and placental dysfunction.

Bicuspid aortic valve (BAV) is the most common congenital heart disease. Severe stenosis of BAV and its combination with aortic pathology can cause significant adverse maternal and perinatal consequences. The optimal strategy for medical care of pregnant women with BAV has not been fully elucidated and requires further research. This paper presents 7.5 years of work experience of a multidisciplinary team of experts in obstetric cardiology and cardiac surgery in the medical care of pregnant women with BAV and co-existing pathology of the heart and aorta. The experience is based on modern international guidelines, our own research efforts and hospital protocols. Primary expert cardiac screening of 2,469 pregnant women revealed 4.3% of patients (n=106) with BAV. The choice of the strategy for their care was personalized and based on the degree of BAV lesions, any concomitant pathology of the heart and aorta, symptoms and life-threatening conditions. The article analyzes the experience of medical care of pregnant patients with BAV bearing high cardiovascular risk (n=24), presents indications for a certain type of medical care, method and place of birth before cardiac surgery during pregnancy. The types and optimal time for performing interventions during pregnancy and the postpartum period were discussed. Perinatal losses (n=3) were analyzed. The chosen strategy is effective, as evidenced by the absence of negative maternal consequences in the immediate and long-term follow-up period.

This paper presents a clinical case of a 39-year-old pregnant woman with respiratory signs of the novel coronavirus Covid-19 infection. Chest MRI showed bilateral lesions in basal segments. The PCR test was positive. A lung condition was assessed without loss of significant diagnostic information. Besides that, the absence of exposure to ionizing radiation allowed to avoid a high loading dose on the patient and the fetus. This case reveals potential opportunities of MRI in the diagnosis of pulmonary pathology without exposure to ionizing radiation, especially in patient risk groups (children, pregnant women, etc.).

Diabetic nephropathy (DN) is specific kidney damage in patients with diabetes mellitus. DN develops relatively often in pregestational diabetes patients (5,9-26%) and stills one of the main limitations for successful pregnancy in this patients’ group. Advanced DN increases risks of poor pregnancy outcomes for women and fetuses including chronic kidney disease (CKD) progression, high rate of preeclampsia, preterm deliveries, Cesarean sections, perinatal mortality and neonatal morbidity. At the same time there are more and more successful pregnancies with advanced DN in the wold.In our paper we systematize global experience of planning and management pregnancies with type 1 diabetes and DN in different stages of renal impairment. We discuss role of nephroprotective therapy in preconception care, achievement and maintaining blood pressure goals, multidisciplinary team care for improvement pregnancy outcomes in type 1 diabetic women with DN.

Objective. To analyze the course of pregnancy and delivery that occurred before and after surgical correction of idiopathic scoliosis with instrumented fixation of the spine. Material and Methods. The paper presents a retrospective randomized study of 100 patients of reproductive age (18–35 years) with Lenke type 2–6 idiopathic scoliosis. The following aspects of pregnancy were analyzed: the possibility of independent conception, the pain severity according to VAS during each of the three trimesters of pregnancy, and the mode of delivery (naturally or by C-section). A comparative analysis of the data of patients operated on for the spine deformity correction before and after pregnancy and delivery was carried out. Data was collected using a questionnaire survey of patients. Detection and analysis of differences between groups were carried out using the χ2 criterion. Results. A statistical relationship was found between the presence of instrumentation installed before delivery (during or before pregnancy) and the need for C-section. It was revealed that the lower the caudal end of instrumentation within the L3–S1 region, the higher the C-section occurrence. Predominantly thoracic scoliosis (Lenke types 2–4) is characterized by higher likelihood of independent conception and lower lumbar pain intensity during pregnancy than predominantly lumbar scoliosis (Lenke types 5–6). There are also certain difficulties in conducting spinal anesthesia in patients with installed instrumentation, which negatively affects the possibility of its use. Conclusion. The issue of the course of pregnancy and delivery in idiopathic scoliosis continues to be very significant for both patients and spine surgeons who supervise them. The solution to this issue is impossible without cooperation with obstetrician gynecologists and anesthetists planning and administering anesthetic management during delivery (which is especially important in case of impossibility or significant restriction of spinal anesthesia use in such patients).

Hereditary angioedema (HAE) is a genetically caused orphan disease with a high risk of developing life-threatening attacks, thus requiring availability for up-to-date information on this problem for the doctors of any specialties. A limited number of observations determine the value of the analysis for each clinical case. Many facets of clinical manifestations, a list of predisposing and triggering factors, as well as limitations of some diagnostic and therapeutic algorithms, require the development of individual management schemes under distinct clinical situations. In this paper, we present the unique clinical cases with certain limitations, describing unexpected onset of the disease in the course of pregnancy, management aspects during delivery and post-delivery periods in a women with a previously confirmed HAE diagnosis. Adapted diagnostic algorithms of postnatal diagnostic verification are presented for children with burdened genetic history. We express some assumptions about involvement of a multidisciplinary team of specialists, personalized approach to building a management plan with an “online” correction depending on observation stage of НАЕ patient.

The paper presents the world’s first clinical case of two full-term successive pregnancies in a patient following simultaneous liver-kidney transplantation with reno-portal transposition. Both pregnancies ended with the birth of healthy children and favorable course of postpartum and long-term periods. The features of management and childbirth are highlighted. Literature review on this problem is presented.

The general practitioner encounters all three forms of insomnia: idiopathic, chronic and acute. Idiopathic and chronic patients should receive specialized care by neurologist, psychiatrist or sleep disorders specialists because they require deep differential diagnosis and complex treatment. Acute insomnia patients need quick help to prevent the negative health impact and chronisation of sleep disruption. In theRussian Federation, the GP has access to three kinds of sleep drugs: benzodiazepines, melatonin receptor agonists, antihistamines. However, modern benzodiazepines are unavailable inRussiaand older benzodiazepines can lead to dependence. Melatonin receptor agonists are not effective enough for acute insomnia. Among available antihistamines, doxylamine is the most convenient option in clinical practice. Doxylamine has a good profile of safety and efficacy, it is included in the local clinical guidelines for insomnia. Also, doxylamine is the only sleep drug available for pregnant women. This paper presents a portrait of doxylamine and comments on its clinical niches and contraindications. We also discuss the pharmacology of doxylamine, drug interactions, and prescription modes. There are also three clinical case studies, presenting the typical acute insomnia patients and logic for their evaluation, underlining key clinical features of this disorder.

Infective endocarditis in pregnant women is a threatening disease that leads to significant maternal and perinatal losses. Methods for caring for such patients have not yet been standardized, and literature sources provide single descriptions of case reports. Objectives. To reduce maternal and perinatal mortality and disability, as well as to provide optimal management and delivery strategy for pregnant women with infective endocarditis. Materials and methods.This paper presents the experience of treating three cases of IE in pregnant women (n-2) and parturient (n-1) by specialists of a national multidisciplinary team. In all three cases, cardiology, cardiac surgery and perinatal tactics were personalized in accordance with the recommendations of the European Society of Cardiologists and the experience of the team members. Parturient with acute IE and septic clot of right ventricle underwent urgent cardiac surgery. Another pregnant was provided with conservative support by a multidisciplinary team due to the absence of indications for immediate surgery (she underwent aortic valve replacement and mitral valve repair in 11 days after in-term labour). The third one underwent cardiac surgery (mitral valve repair) with fetus in utero at 21 weeks of pregnancy after 11 weeks of de-escalation therapy by antibiotics. Results. In all cases, the immediate maternal and perinatal results were good. Follow-up for two cases we could observe (33 and 18 months after surgery) are good. Conclusions. Treatment tactic for pregnant women with acute IE that require heart surgery is always a compromise between the treatment and rehabilitation of a deep-preterm baby and the intra-operative risks to the fetus. Risk of intervention for mother and fetus can be minimized by a highly professional multidisciplinary team with wide experience in open-heart surgery, competent preparation of women for surgical treatment, conducting intraoperative fetal monitoring, as well as using special parameters of artificial circulation and anesthesia. Primary and secondary prevention of infectious complications in pregnant women at risk of IE is a powerful tool to reduce maternal, perinatal mortality and disability.

Many publications in foreign and domestic papers are devoted to pyelonephritis in pregnancy. At the same time, aspects of the upper urinary tract (UUT) drainage, indications / lack of indications, and the duration of UUT drainage during kidney infections in pregnant women are bypassed. Etiological treatment of this pathology is well described in the European Association of Urology guidelines and American Urological Associations guidelines in accordance with the recommendations of the Food and Drug Administration (FDA). However, there are no references to the management of patients with UUT dilatation, associated with pyelonephritis in pregnant women. The Russian Clinical Guidelines for Urology (2018) also contains very brief information on this issue. Thus, each urological clinic of the Russian Federation has formed its own views on the draining tactics for pyelonephritis in pregnant women, which our colleagues have been following for years and decades. This publication presents an analysis of the literature sources focusing on the current state of the problem of pyelonephritis in pregnancy and the «neсessity» of the UUP drainage. It is intended to initiate a review of the established «tradition» and avoid a significant number of catheter and stent-related complications.

Background. Hodgkin’s lymphoma (HL) is a malignant disease of lymphoid tissue, which is characterised by the appearance of giant Reed—Berezovsky—Sternberg cells in the lymph nodes affected by the pathological process. These cells can be detected through microscopic examination. Currently, HL is one of the most treatable oncological diseases. In recent years, the recovery rate in patients suffering from this pathology has increased (70–90%), almost reaching the recovery rate in patients starting treatment at the early stages. Given the above, the quality of life in these patients during remission is becoming more important, since most of them are women of childbearing age planning to have children. In this connection, it is of great importance to study the course of pregnancy and labour, along with their effect on the possibility of a relapse, in such patients.Aim. In this paper, we set out to analyse the course of pregnancy and childbirth in a patient suffering from HL.Materials and methods. We studied the medical records (including medical history and pregnancy records) of a patient whose pregnancy occurred in the setting of a severe oncological pathology – HL in remission. The patient underwent a thorough examination and the baby was successfully delivered.Result. The outcome of pregnancy and childbirth for the patient and foetus was studied in the setting of a severe oncological pathology (HL in remission).Conclusion. The pregnancy of a woman suffering from a serious oncological pathology (HL in remission) was prolonged to full-term and successfully completed. The patient was able to experience the joy of motherhood for the third time.

Introduction: Toxoplasmosis is a disease caused by Toxoplasma gondii protozoan. Toxoplasmosis is particularly dangerous for the foetus and any infection, regardless of the period of pregnancy, may cause disorders in the extra-fetal life. The paper assesses the knowledge of women about toxoplasmosis infection, basic definitions and prophylactic measures. Aim: The aim of the study was to investigate the level of knowledge of women about Toxoplasma gondii infection, as well as the basic preventive actions. Material and method: The study was conducted in the period from February to June 2016 by means of a diagnostic survey. 63 women aged 20 and over took part in the survey. The tool used in the study was a questionnaire. The most numerous group were the respondents aged 20-29 years and the least aged 40-49 years. The research results were developed in Microsoft Excel and Statistica 13.1. Results: The analysis of the collected data shows that women with higher and secondary education have the greatest knowledge of both defining and basic preventive measures. Conclusions: The level of women's knowledge about Toxoplasma gondii infections varies according to the education of the respondents. The knowledge about basic preventive measures that can significantly reduce the serious consequences of Toxoplasma gondii infections for the developing fetus should be disseminated.

The paper details 15 new recommendations of the Canadian Rheumatology Association for the clinical monitoring of patients with systemic lupus erythematosus (SLE). During their development, the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) classification system for rating the quality of recommendations was used for the first time. The recommendations for physician specialization; cardiovascular risk assessment; anti-Ro/SSA and anti-La/SSB antibody concentrations examination during pregnancy; and annual influenza vaccination are considered to be strong; those for rating disease activity and damage index; ultrasound of the carotid arteries; diagnosis of osteoporosis and osteonecrosis; Doppler ultrasound of uterine and fetoplacental blood flow during pregnancy; screening for cervical cancer, viral hepatitis B and C in patients with SLE are regarded as conditional.

The paper presents research data regarding the effect of secondary prevention of preeclampsia in pregnant women of the high-risk group for this disease, which was formed at 18-20+6 weeks of pregnancy by detecting placental hypoperfusion during the second ultrasound screening. The assessment of blood flow in the uterine spiral arteries in the area of the placental site was performed in women with anamnestic risk factors for preeclampsia, namely, complicated gynecological history; first pregnancy, obstetric history; family history of preeclampsia; women of young and older reproductive age; presence of extragenital pathology, accompanied by the increase in blood pressure (chronic arterial hypertension, chronic kidney disease); overweight (body mass index 25.1-29.9) and obesity (body mass index 30 or more); anomalies in the developme nt of the uterus; history of delayed sexual development; unbalanced diet. The study included examination of 121 pregnant women (30 healthy pregnant women − the control group and 91 pregnant women with reduced blood flow in the uterine spiral arteries in the area of the placental site; this group was divided into two subgroups, the first subgroup consisted of 32 women who refused preventive treatment, and the second − 59 pregnant women taking preventive treatment). In the subgroup of the main group of women examined, who refused the proposed preventive treatment, later (up to 28-34 weeks of pregnancy) preeclampsia occurred in almost 50% of cases; moreover, a progressive decrease in blood flow in the vessels of the uteroplacentalfetal complex was determined. The introduction of proposed method of secondary prevention of preeclampsia in pregnant women at high risk for this disease (metformin, vitamin D3 and corvitin) makes it possible to reduce the incidence of clinical manifestations of preeclampsia by 1.4 times compared with the group that refused the proposed treatment, and to prevent blood flow disorders in the uteroplacentofetal system: the pulsation index has significantly decreased in the uterine vessels, reaching those of the control group; the values of all vascular resistance indices in the spiral arteries located in the placental site area, in the umbilical arteries and in the fetal middle cerebral artery, also reached those in the control group.

This paper summarises scientific literature on pharmacotherapy of epilepsy in pregnant women from the perspective of clinical pharmacology. It analyses general principles of antiepileptic therapy in pregnant women. It was demonstrated that the optimal conditions for treating epilepsy during pregnancy involve the use of the minimum dose of an anticonvulsant. The article describes specific pharmacokinetic parameters of antiepileptic drugs (valproic acid, carbamazepine, lamotrigine, phenytoin, phenobarbital) that require adjustment of the dose regimen based on therapeutic drug monitoring. It was demonstrated that carriership of «slow» allelic variants of CYP2C9 is associated with a slowdown in hepatic biotransformation of valproic acid, carbamazepine, topiramate, phenytoin, oxcarbazepine, diazepam, phenobarbital, and primidone, and, consequently, with increased drug concentrations in blood plasma and an increased risk of adverse reactions. Taking into account polymorphism of genes encoding metabolic isoenzymes of traditional antiepileptic drugs, it is recommended for pregnant women and women planning a pregnancy to undergo genotyping. It was demonstrated that polymorphism of the ABCB1 gene and genes of other transport proteins can modify the effect of antiepileptic drugs on the foetus, thus increasing the teratogenic risk.

Objective: to clarify pregnancy outcomes in patients with ankylosing spondylitis (AS) and its course during pregnancy on the basis of a retrospective analysis.Subjects and methods. The paper presents the results of Stage 1 of a Russian pilot study of the impact of pregnancy on AS activity, parity, and pregnancy outcomes in these patients. The basis for Stage 1 is the results of a retrospective analysis of the data of a questionnaire survey of 204 women with AS, during which they answered 19 questions regarding the presence of pregnancies and their outcomes, the reasons for the lack of pregnancies, and a subjective assessment of their health status during gestation. The respondents’ mean age was 32.0±5.8 years; the mean disease duration was 107.2±73.5 months.Results and discussion. 84 (41.1%) women did not have pregnancies; the reasons for the lack of pregnancies were associated with AS (fear of the teratogenic effect of taken drugs; a child’ inheritance of the disease) in 48.8% of the cases, with infertility in 9.5%, and with non-medical reasons in 41.7%. A total of 120 (58.9%) women had 248 pregnancies; of whom 136 patients had the latter before and 112 – after the onset of AC. In AS versus a healthy life period, there were lower abortion rates at a woman’s will (8.9 and 35.3%, respectively; p < 0.01), more pregnancies that resulted in childbirth (75.9 and 52.2%, respectively; p < 0.01), and higher surgical delivery rates (43.5 and 28.2%, respectively; p < 0.05). The premature birth rate after the onset of AC was 13.0%. The newborn infants born before the onset of AS in mothers did not differ from those born after the onset of AS in mothers in weight and Apgar scores. Half of the respondents reported that their health status was improved in any trimester of pregnancy (slightly more often in the first trimester; but the difference was statistically insignificant). However, almost 70.0% of the respondents noted their worse health status during pregnancy, the severity of AS symptoms increased with a gestational period.Conclusion. The reason for the lack of pregnancies in almost half of the patients with AS is associated with their subjective fear of the negative impact of the disease and therapy on a child’s future health. In AS versus a healthy life period, surgical deliveries are performed more frequently. The neonatal outcomes of pregnancies do not differ before and after the onset of AS.

The paper presents a clinical case of the Patient T., 34years old, who underwent the treatment in the Department of ART of the Regional Perinatal Center for tubal peritoneal infertility for seven years. In the anamnesis: one spontaneous uterine pregnancy, culminating in medical abortion for up to 12 weeks, treatment for chronic salpingo-oophoritis, tubectomy on the right side for a progressing ectopic pregnancy. The patient denied the presence of Chlamydia infection in the anamnesis. Studies on sexually transmitted infections before the 1VF program were negative. During laparoscopic tubectomy, no endometriotic foci were found. There were four programs of ART in anamnesis: in 2009, 2012, 2014,2016. During the fourth ART program in 2016, two embryos were transferred to the uterine cavity, resulting in a uterine pregnancy in combination with an ectopic pregnancy diagnosed in the ultrasound study at 4 to 5 weeks of gestation, in the absence of clinical symptoms. The patient underwent emergency laparoscopic tubectomy on the left, the course of the postoperative period proceeded without complications. Later, in the period of uterine pregnancy of 7-8 weeks, with a clinical picture of acute appendicitis, the woman was hospitalized in the surgical department where she underwent laparoscopic appendectomy. Later the pregnancy proceeded without complications, at 39 weeks the planned cesarean section was performed, a girl weighing 3480 grams, 51 cm long with an Apgar score of 9-10 points was extracted on the operation. The course of the early postoperative period without complications, the patient was discharged with the child on the 4th day.

The paper presents experience in following up and treating hairy cell leukemia (HCL) during pregnancy. The combination of HCL and pregnancy was observed in 5 patients. The patients’ median age was 35 years (range, 28—42 years). The diagnosis of HCL was based on a conventional examination protocol: clinical blood analysis with the morphological assessment of lymphocytes, a myelogram and trepanobiopsy, immunophenotypic analysis of lymphocytes or bone marrow (in all the patients), cytochemical determination of tartrate-resistant acid phosphatase in 3 patients, and identification of BRAFV600E mutation in 3 patients. Three pregnant women were treated for HCL in the postpartum period. In one patient with HCL, pregnancy was seen in remission after treatment with cladribine. In one patient with HCL detected at 11 weeks’ gestation, interferon-α therapy during the second trimester of pregnancy was performed for increased cytopenia, which was followed by cladribine therapy after delivery. Pregnancy and delivery were uncomplicated in all the patients; 3 patients had vaginal delivery and 2 patients underwent cesarean section. All infants were healthy, with no developmental abnormalities during a follow-up period of 6—140 months (median 30 months). All the patients with HCL are currently in remission: 4 patients in first remission at a follow-up of 10 to 48 months (median 15 months) and one patient in second remission at a follow-up of 88 months. Possible observational tactics is possible when HCL is detected during pregnancy. Treatment of HCL during pregnancy is necessary in cases of deep or progressive cytopenia and/or splenomegaly. The use of interferon-α or splenectomy is preferable.