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Background. Human papillomavirus refers to one of the most common sexually transmitted infections with the majority of viruses in the host being transient carriers, the so-called latent forms of papillomavirus infection. Persistence of cancer-associated human papillomavirus is fraught with cervical intraepithelial neoplasia, and subsequent cervical cancer. Measures for secondary prevention of cervical cancer in latent forms of papillomavirus infection are yet to be developed, which predetermined the present study.Objectives. To increase the effectiveness of secondary prevention of cervical cancer by improving the algorithm for managing latent forms of papillomavirus infection in women. Methods. A randomized controlled trial enrolled 152 patients diagnosed with a latent papillomavirus infection. Patient examination and data analysis were carried out at clinical trial centers of the Department of Obstetrics, Gynecology and Perinatology of Kuban State Medical University (Russia) in 2020–2024. The trial involved patients aged 18 to 35 years. Patients were divided into 2 groups using the sealed code envelope method: Group I (comparison group) (n = 74) — microbiological sanitation of the cervicovaginal zone (as indicated) and observation for 36 months with annual control of viral load, colposcopy and oncocytology; Group II (study group) (n = 78) — microbiological sanitation of the cervicovaginal zone (as indicated) and administration of quadrivalent recombinant human papillomavirus vaccine (types 6, 11, 16, 18) (3 doses intramuscularly: second and third doses were administered 1 and 3 months after the first one). Each patient was analyzed for the effectiveness of preventive therapy according to the dynamics of indicators: colposcopy, cytology (Papanicolau staining), and molecular biological analysis (polymerase chain reaction). The indicators were evaluated after 12, 24, and 36 months. Statistical analysis of the results was carried out using IBM SPSS Statistics 26 (IBM, USA) variation statistics programs.Results. Vaccination with a quadrivalent recombinant vaccine against human papillomavirus of types 6, 11, 16, 18 against the background of correction of dysbiotic vaginal and cervical disorders in latent forms of papillomavirus infection in women was revealed to cause a 9.3-fold decrease (compared to the study group) in realization of latent persistence of viruses into subclinical (25.7 % in group I vs. 9.0 % in group II) and clinical forms of papillomavirus infection (cervical intraepithelial neoplasia) — 12.1 % in group I vs. 1.3 % in group II, to reduce the persistence of human papillomavirus and the appearance of their new genotypes, the viral load of highly oncogenic types of human papillomavirus (1.9 times —3.2 ± 2.4 geq/ml in group I versus 1.7 ± 2.1 geq/ml in group II).Conclusion. The trial has shown that human papillomavirus vaccination is associated with a reduced risk of realization of latent forms of papillomavirus infection into clinical forms as cervical intraepithelial neoplasia and, consequently, cervical cancer, thereby being considered promising for secondary prevention of this pathology.

Background. The relevance of the problem is related to the high prevalence of chronic endometritis (CE); its role in female infertility, implantation failures during assisted reproductive technology procedures, and recurrent miscarriage; as well as the lack of a unified strategy in the diagnosis and treatment of this pathology. The present systematic review with a meta-analysis focuses on evaluating the impact of CE and its therapy on the outcome of in vitro fertilization. In addition, the effect of CE of various severity on the outcomes of assisted reproductive technologies is analyzed. Objective. To analyze the effect of CE of varying severity and its treatment on the outcomes of in vitro fertilization. Methods. Using PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry, and Russian Science Citation Index, a systematic search was conducted for articles published over the past 12 years that met the following criteria: randomized controlled trial examining the effect of CE of varying severity on fertility and ways to treat it. The following indicators were calculated: ongoing pregnancy/live birth, clinical pregnancy, and miscarriage rates. A total of 4145 patients (from ten studies) were included. A meta-analysis was performed using Stata 11.0 software (The Cochrane Collaboration, Oxford, UK). The heterogeneity was considered low at I2 50%. Results. Women with CE exhibited lower ongoing pregnancy/live birth (OR 1.97; p = 0.02) and clinical pregnancy rates (OR 2.28; p = 0.002) as compared to women without it. CE treatment increased the ongoing pregnancy/live birth (OR 5.33; p < 0.0001) and clinical pregnancy rates (OR 3.64; p = 0.0001). In vitro fertilization outcomes were comparable in women treated for CE and women without CE (ongoing pregnancy/live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Women with severe CE exhibited lower ongoing pregnancy/live birth (OR 0.43; p = 0.003) and clinical pregnancy rates (OR 0.40; p = 0.0007). Mild CE showed no significant effect on in vitro fertilization outcomes (ongoing pregnancy/ live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Conclusion. The conducted meta-analysis showed that CE significantly reduces the ongoing pregnancy/live birth and clinical pregnancy rates in infertile women undergoing in vitro fertilization. Noteworthy is that antimicrobial therapy in such patients improves the results of assisted reproductive technologies, which are comparable to those of patients without CE. The negative impact of this pathology on the implantation capacity of the endometrium is most often observed in the severe form, while its mild form has virtually no effect on the in vitro fertilization outcome.

Objective: assessment of the microbiome of the vagina and uterine cavity using a uterine catheter with a collet guide in infertile patients before the in vitro fertilization procedure. Materials and methods: samples of vaginal and endometrial scrapings obtained from 73 infertile women who had planned an in vitro fertilization (IVF) procedure were taken and studied. The samples were analyzed by V3-V4-V6 regions using the 16S rRNA gene sequencing method. Results: significant differences were found in the taxonomy of the endometrium and vaginal microbiome - coincidences in microbiological composition were detected in 18.2% of patients. Endometrial lactobacillus-dominant microbiocenoses occurred in 24.8% of women, vaginal — in 56.7%. Comparisons between patients with negative and positive IVF (onset of biological pregnancy) results failed to identify any microorganism associated with the success of the procedure, with endometrial microbiota biodiversity being higher among women who successfully exercised their reproductive function. The Shannon Equality Index (J) for pregnant and non-pregnant women was 0.76 (0.57–0.87) and 0.55 (0.51–0.64), respectively (p=0.002). Conclusion: the use of a developed uterine catheter with a collet guide for an adequate assessment of the endometrial microbiome is promising and justified. The correct assessment of the endometrial microbiocenosis contributes to the adequate diagnosis of pathological processes occurring in the uterine cavity, which will allow for proper therapy aimed at increasing the receptivity of the endometrium and, in the future, contributing to the realization of the reproductive function of a woman.

Background. Relevance of the study is related to the lack of a unified strategy for determining the risk of infectious complications of puerperium. Currently, the specialists use the collected data from studies documenting the main factors of infection in a population or cohorts of postpartum women. However, accuracy of these factors is not established and prognosis could not be personalized. The paper analyzes significant risk factors for the infectious complications associated with cesarean section (C-Section) and develops a model for their prognosis and an individual assessment of the risk of postpartum infection in order to take timely preventive measures. Objective. To identify predictors of postpartum purulent-inflammatory complications after cesarean section, to evaluate their predictive value, and to develop a statistical model for determining the risk of their occurrence.Methods. The cohort retrospective study (January 2019 to January 2022) was conducted in four obstetric health facilities of Krasnodar and was focused on analysis of medical records. Anamnestic, clinical and laboratory data of all women after cesarean section delivery were collected. Model: a patient diagnosed with any infection associated with cesarean section within 42 days after delivery — postoperative suture infection, endometritis, peritonitis, thrombophlebitis, sepsis. Infections were grouped to carry out a single risk assessment with an internal validation test and to develop a multifactor logistic regression model. All analyses were conducted using version R 3.2.3 (SPSS Inc., Chicago, IL) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD).Results. Infection associated with cesarean section occurred in 2.50% of women (n = 548; 95% CI 2.6–3.5), suture disruption — in 0.59% (n = 129; 95%, CI 0.41–0.81), endometritis — 1.46% (n = 321; 95%, CI 1.15–1.94), peritonitis — 0.16% (n = 35; 95%, CI 0.11–0.20), thrombophlebitis 0.04% (n = 9; 95%, CI 0.01–0.05), sepsis 0.25% (n = 54; 95%, CI 0.15–0.35). The authors have identified 14 major variables with a high prognostic risk for the development of infectious complications of puerperium. The model differentiated women with and without purulent inflammatory complications of puerperium by internal validation (concordance index = 0.712, 95%, CI 0.672–0.755).Conclusion. The developed model can be used to accurately predict the risk of infectious complications after abdominal delivery and to identify high-risk patients. It ensures a differentiated approach with a possibility to expand studies and strengthen antibiotic therapy, which promotes reduction of surgical site puerperal infection.

Objective: identify the main risk factors in the development of purulent-inflammatory complications after cesarean section. Materials and methods: puerperal women after cesarean section (n = 90): 24 patients with a complication of puerperia in the form of endometritis (group I), 16 — with the insolvency of the suture on the uterus (group II) and 50 — with a physiologically occurring postoperative period (group (III) of control). An analysis of anamnestic, clinical and laboratory studies of puerperal women after abdominal delivery with a complicated postoperative period was carried out. With the help of logistic regression with the construction of an ROC-curve, a rank correlation analysis of the influence of adverse factors with the calculation of diagnostic coefficients (DC) was performed. Results: based on the assessment of the identified main clinical-anamnestic and laboratory predictors, using mathematical modeling methods, a scale for predicting the risk of purulent-inflammatory complications in early puerperia after abdominal delivery has been developed. Conclusion: prognostic mathematical scale for assessing the risk of purulent-inflammatory complications in puerperal women after abdominal delivery makes it possible to identify the main predictors of infectious diseases in these patients, which contributes to their timely prevention and, thereby, reducing the frequency of severe forms of postpartum infection.

Purpose: comparative study of the structure of infertility and outcomes of ART programs among patients of different age groups. Materials and methods: the case histories of 180 patients with infertility were studied: Group I ≥ 35 years old; Group II

Background. The relevance of the problem is supported by the lack of effective secondary prevention measures against human papillomavirus (HPV)-associated cervical intraepithelial neoplasia (CIN) and cervical cancer. The only currently verified treatment for lower genital neoplasia is destructive therapy, with the recurrence rate of viral infection remaining quite high even after such interventions. The preventive role of HPV vaccine at pre-existing cervical lesions is actively debated worldwide, but the evidence remains scattered and contradictory. The present study surveys the scientific publications available that evaluate the efficacy of human papillomavirus vaccination as a secondary prevention measure against related cervical pathology.Objectives. An evidence survey on the efficacy of adjuvant vaccination against human papillomavirus in patients undergoing destructive therapy for cervical intraepithelial neoplasia.Methods. We have conducted a 10 year-depth review of scientific literature on the adjuvant human papillomavirus (HPV) vaccination efficacy for reducing the recurrence risk of precancerous cervical neoplasia. The results are presented in form of the difference of mean or pooled 95% confidence-interval odds ratios (OR; 95% CI). Statistical analyses were conducted with Review Manager v. 5.4 (The Cochrane Collaboration, 2020).Results. Thirteen Russian- and English-language studies were selected for final analysis. A total of 21,702 cervical dysplasia patients were included: 5,941 (27.4%) received a perioperative HPV vaccine, while 15,761 (72.6%) only had surgical treatment. Recurrences of CIN I (mild cervical intraepithelial neoplasia; OR 0.45, 95% CI 0.27–0.73; p = 0.001) and CIN II (moderate cervical intraepithelial neoplasia; OR 0.33, 95% CI 0.20–0.52; p

Introduction. The article presents a comparative analysis of the treatment of patients with combined estrogen-dependent pathology of female reproductive system: fibrocystic mastopathy and endometrial hyperplasia without atypia. The experience of treatment with an indole-carbinol-containing drug as monotherapy while using a levonorgestrel-releasing intrauterine system is presented.Aim. To evaluate the clinical efficacy of indolecarbinol in the treatment of patients with combined estrogen-dependent pathology of the female reproductive system.Materials and methods. The authors studied the responses to the treatment of patients with fibrocystic mastopathy and simple endometrial hyperplasia (n = 65) with the indole-carbinol-containing drug at a dose of 400 mg once daily for 12 months. All patients were divided into two groups: Group I (n = 32) – women who refused hormone therapy (indole-carbinol monotherapy); Group II (n = 33) – the use of indole-carbinol while using the levonorgestrel-releasing intrauterine system. Diagnostic methods: clinical and laboratory examination, ultrasound examination of mammary glands and pelvic organs, mammography, nipple discharge cytology at baseline and 6 and 12 months after the start of therapy. Before study group assignment to treatment, all patients underwent hysteroscopy with endometrial biopsy and histological examination. Descriptive statistics were used to evaluate the data: p-values below 0.05 were considered statistically significant.Results and discussion. The presented experience in treating women with combined pathology of the female reproductive system (fibrocystic mastopathy and endometrial hyperplasia without atypia) with the indole-carbinol-containing drug showed high clinical efficacy in mastopathy (relief of mastodynia (83.0 ± 1.6%), improvement of the ultrasound view of BI-RADS (66.1 ± 1.4%), reductions in mammographic density (66.1 ± 2.1%, p < 0.05)), high tolerability and satisfactory compliance. This drug combined with hormone therapy is recommended for the treatment of endometrial hyperplasia.Сonclusion. The use of indole-carbinol in the treatment of benign hyperplastic processes in mammary glands and endometrial hyperplasia is pathogenetically substantiated and shows high clinical efficacy

Objective: To assess the diagnostic value of biomarkers: microbiological, molecular and biological, immunological biomarkers, characteristic of various types of recurrent myoma-associated growth.Materials and Methods: Seventy women of reproductive age with recurrent uterine myoma and its combination with adenomyosis after conservative treatment in the Clinic of Kuban State Medical University were examined. Methods: microbiological examination, sonography, Doppler sonography, histology, immunohistochemistry, morphometry.Results: The type of recurrent myoma-associated growth was proved to be dependent on molecular and biological characteristics of tumors, the presence of infection and blood perfusion. It was indicated that women with recurrence of myoma-associated growth of a “false” type were characterized by high rates of infections (the presence of reproductive losses, chronic inflammatory diseases of the pelvic organs) and significant bacterial contamination of the genital tract biotopes. Blood perfusion features were identified for true and “false” types of recurrent myoma-associated growth based on Doppler sonography data, which were consistent with features of tumor vessel morphometry. Analysis of uterine myoma histological types and their vascularization features showed correlation of forms with a high proliferative potential of a tumor on a molecular and cellular level to moderate and high expression of steroid hormone receptors in combination with Ki67, a significant diameter of the lumen of the vessels with the highest VI and VFI values.Conclusions: A comprehensive study of women with uterine hyperplasia determines the possibility of prediction of pathogenetic variants of recurrent myoma-associated tissue growth and adequate choice of treatment options and rehabilitation course.

Objective. The study aimed to compare the diagnostic value of different methods of assessing the condition of the scar on the uterus after a cesarean section.Materials and methods. A comparative analysis of the diagnostic value of assessing the validity of the scar on the uterus in the pre-graviridar period and during pregnancy ultrasound (ultrasound) investigation with dopplerometry (DM), magnetic resonance imaging (MRI), and microwave radiothermometry (RTM). The study included fertile patients after delivery by cesarean section (n = 56), at the planning stage, during pregnancy and after delivery, both through natural birth pathways and by re-cesarean section.Results. A comparative analysis of the assessment of the scar in the uterus by the mentioned methods revealed the comparable diagnostic value of these methods during the planning phase of pregnancy and in gestation time 11–12 and 20 –21 weeks, while at the period of 37–38 weeks, the sensitivity of RTM was significantly (1.6 times) higher than ultrasound investigation.Conclusions. Despite the high diagnostic effectiveness of all three methods of assessing the condition of the uterine scar after cesarean section, the method of microwave radiothermometry has advantages in the simplicity of the method, lack of need for expensive equipment, and specialized qualifications of the doctor.

Background. Endometrial infertility is a frequent cause of failure in assisted reproduction. Causes of endometrial infertility are manifold and require comprehensive assessment for a successful choice of treatment strategy.Objectives. A review of infertility concepts accounting for endometrial infertility in women of late reproductive age.Methods. Bibliographic analysis: sources for review were mined in the PubMed, MedLine, eLibrary and Cyberleninka databases at a depth of 10 years. Keyword queries were: endometrial factors of infertility, uterine infertility [маточные факторы бесплодия], causes of infertility. Selected articles related to female infertility and, particularly, endometrial factors of infertility. Low-informative articles were not considered.Results. A total of 51 sources were analysed, with 36 selected in the review. The reviewed evidence suggests that endometrial female infertility in late reproductive age is associated with cumulative gynaecological pathology and age-related change adversely impacting endometrial receptivity and synchrony with embryo maturation in assisted reproductive protocols.Conclusion. Determining the functional status of endometrium is prerequisite for the outcome prognosis in assisted reproduction due to feasible failures to conceive with a vital embryo but reduced endometrial receptivity. This observation warrants a timely diagnosis and treatment of endometrial disorders prior to having assisted reproductive interventions. Woman’s age is the main predictor of successful pregnancy in IVF/ICSI protocols. Among the main markers of successful implantation is endometrial thickness. Uterine infertility may relate to impaired local immunity and autoimmune responses in uterine cavity. The most common mechanisms of uterine infertility are associated uterine myoma, endometriosis and endometritis. Women with uterine infertility attempting IVF/ICSI procedures often exhibit asynchronous endometrial development relative to the embryo maturity for implantation.

Introduction. Vaginal infections of nonspecific etiology caused by microbiocenosis disorder is one of the leading aspects of gynecological morbidity in recent times. According to research statistics, the incidence of such disease varies from 30 to 80% among all inflammatory lower genital tract diseases in women. Aim of the study: to present the experience of preparation for ART in patients with chronic endometritis against the background of mixed forms of vaginal dysbiosis. Material and methods. The results of treatment with a drug containing metronidazole and miconazole nitrate (vaginal suppositories once a day at bedtime for 7 days) were studied in combination with natural micronized progesterone in 36 women with infertility caused by endometrial receptivity disorder due to chronic endometritis against the background of vaginal dysbiosis, in whom pre-implantation preparation with embryo transfer was carried out after the end of the therapy. The following were used: assessment of microbiota status of urogenital tract – PCR (femoflor-16), measurement of vaginal environment pH, Hay/Ison criteria, endometrial pipelle biopsy and endometrial immunohistochemical evaluation of endometrial receptivity (LIF, LIF-R) on the 3rd and 7th days after LH peak. Conclusion. The presented experience of complex local therapy of women diagnosed with “Infertility against the background of chronic endometritis and vaginal dysbiosis“ using a drug containing metronidazole and miconazole and natural micronized progesterone in the form of vaginal gel can be useful for practicing obstetricians-gynecologists and other interested specialists.

Introduction. The article discusses the possibilities of comprehensive management for patients with Asherman’s syndrome.Objective: to describe the experience in comprehensive management of patients with Asherman’s syndrome using an enzymatic proteolytic agent – bovgyaluronidase azoximer.Material and methods. A total of 43 patients with Asherman’s syndrome were examined. The examination methods included transvaginal ultrasound (TVUS), hysteroscopy, intrauterine dissection of synechia, endometrial histopathological examination, IL-6, IL-10, VEGF-A and TGFβ1 test in cervical mucus. The treatment included hysteroscopy, dissection of intrauterine synechia and use of Longidaza I.M. at a dose of 3000 IU once every three days for the course – 5 injections followed up by 1 supposidoitory (3000 ME) intravaginally once every two days for the course – 15 applications) on the top of already administered cyclic estrogen gestagen therapy.Results. A statistically significant reduction of anti-inflammatory index (AII) and TGFβ1/VEGF-A ratio in cervical mucus up to the test results of healthy women of reproductive age (controls) was observed in assessing changes in the local immunological status in patients with Asherman’s syndrome under pressure of azoximer bovgioluronidase therapy after 6 months of observation. AII – 0.68 (0.02) c.u. Group 1 against 0.65 (0.03) c.u. (in control), p = 0.87 and TGFβ1/VEGF-A – 1.8 (0.3) c.u. against 1.4 (0.2) c.u. accordingly, p = 0.84.Сonclusions. Analysis of clinical efficacy of azoximer bovgyaluronidase in the comprehensive management of 21 women with second-grade intrauterine synechia showed recovery of menstrual cycle in 18/21 (85.7%) patients, relief of menstrual pain in 11/21 (52.3%) patients. 6/21 (28.5%) patients with infertility and 2/21 (9.5%) patients with miscarriage obtained spontaneous pregnancy 12 months after the therapy. All pregnancies ended in term births.

Introduction. A genital human papillomavirus infection receives the sword-point attention of both researchers and practitioners, due to its large prevalence in the human population, high contagiousness and, in particular, the ability of some HPV strains to contribute to the development of malignancy. This is particularly so with cervical cancer (CC), one of the most common types of cancer both in the Russian Federation and most countries of the world. It ranked first among the causes of malignant tumour deaths of women aged over 30 years. Objective. To present the experience in using the 3,3’-diindolylmethane-containing drug in the treatment of patients with HPVassociated low-grade cervical intraepithelial lesion. Material and methods. 62 women with HPV-associated low-grade cervical intraepithelial lesion were examined and received treatment with the 3,3’-diindolylmethane-containing drug (Cervicon-DIM). The primary diagnosis and therapeutic outcomes monitoring included the following research methods: colposcopy, histological examination of biopsy cervical specimens, Pap test, RT-PCR of high carcinogenic risk (HCR) HPV. The therapy compliance was evaluated using the clinical psychological test method (Morisky Green scale): compliant patients 4 scores (noncompliant 2 scores or less, insufficiently compliant 3 scores). Results. The therapeutic outcomes using 3,3’-diindolylmethane-containing drug (Cervicon-DIM) in the form of vaginal suppositories (100 mg twice daily for 90 days) showed clinical (recovery of colposcopic status in 83.0% of patients), cytological (confirmed absence of LSIL in 98.3% of women) and microbiological (PCR-negative HCR HPV in 91.5% of women) efficacy with satisfactory tolerance of the drug. Сonclusions. The therapeutic outcomes obtained using 3,3’-diindolylmethane-containing drug in the treatment of patients with HPV-associated low-grade cervical intraepithelial lesion could be considered as satisfactory. The data presented may be of interest to practicing gynecologists and other specialists.

Aim. To evaluate the clinical and immunological features of the early gestational period in patients with adenomyosis.Materials and methods. The study included 110 patients with first spontaneous pregnancy in 6–9 weeks. 75 pregnant women with a history of grade 1 adenomyosis were divided into two groups: group 1 comprised 43 patients with a threatened miscarriage, group 2 included 32 patients without a threat of pregnancy termination. Group 3 (control) included 35 pregnant women without a burdened history with a physiological pregnancy course. The cytokine profile of peripheral blood and cervical mucus was studied, as well as the level of LL-37 (cathelicidin) antimicrobial peptide.Results. A pro-inflammatory shift of the cytokine balance as well as increased pro-angiogenic activity, determined by the VEGF-R2 / VEGF-A ratio, were observed in pregnant women with grade 1 adenomyosis during a physiologically ongoing pregnancy in the 1st trimester. A threatened miscarriage in the presence of adenomyosis is accompanied by statistically significant changes in the cytokine profile, a decrease in pro-angiogenic activity and an increased level of LL-37 in cervical mucus.Conclusion. Pregnancy with adenomyosis of the 1st degree, in the absence of other risk factors, is complicated by a threatened miscarriage in more than half of cases. The revealed clinical and immunological aspects of early reproductive losses require further in-depth study, since these signs may indicate the presence of chronic endometritis in patients with adenomyosis not determined by non-invasive research methods.

Aim. To evaluate and analyse features of abdominal delivery in maternal care institutions (level III) in Krasnodar Krai on the basis of M.S. Robson’ obstetric care criteria (2001) and indicators of cesarean section efficacy.Materials and methods. A retrospective study of archives from two Krasnodar Krai obstetric institutions (level III) (the perinatal centres of the Children’s Regional Clinical Hospital and the Regional Clinical Hospital No. 2) was carried out. The material for analysis was the number of births, surgery activity and perinatal mortality indicators (2017).Results. A comparative analysis of abdominal delivery in two leading perinatal centres of the Region revealed low levels of cesarean section efficacy. The monitoring of obstetric conditions, which had the greatest influence on the growth of abdominal delivery cases, was carried out using M.S. Robson’ system. It was revealed that the largest increase in abdominal delivery was observed in patients included in groups I and V.Conclusion. Despite the fact that the efficacy of abdominal delivery in Krasnodar Krai maternal care institutions (level III) is low, a detailed individualised analysis of indications for the performed surgical labour revealed obstetric practices (uterine scars, fetal distress, anomalies in labour), which increased the level of surgical activity. However, taking into account the specificity of indications for hospitalisation of patients in these medical institutions (severe extragenital pathology, complicated pregnancy), an increase in operative activity and low effectiveness of cesarean section are justified.

Objective: to assess the course of pregnancy, childbirth and postpartum period in patients with adenomyosis 1 and 2 degrees.Materials and methods: the course of pregnancy and its outcomes were analyzed in 153 primordial women with a history of adenomyosis of 1–2 degrees (I group), the control group (II group) — 150 conditionally healthy primordial women. Results: in preterm patients with adenomyosis of 1 and 2 degrees, in the absence of problems with conception and somatic pathology, statistically significantly increases the number of early reproductive losses and premature birth during pregnancy statistically significantly more often formed placental insufficiency and increases the frequency of hypertension disorders, increases the frequency of pathology of labor and postpartum period, mainly associated with increased blood loss. Conclusion: complications of gestation, pathology of labor and postpartum period in patients even with 1 stage of adenomyosis are largely associated with histological, immunohistochemical and immunological features of the structure of the transition zone «endometrium-myometrium». Pathological processes occurring in the zone of remodeling of spiral arterioles may lead to abnormal chorion formation, which causes most obstetric complications.

Objective: in women over 35 years of age, there is a progressive and age-related decline in fertility, which is due to multiple consequences, including a decrease in follicular reserve. Cytokines play a role, mediating the interaction between oocytes and other cells. In addition, there is a change in the expression of mRNA of a number of genes, leading to a decrease in the ability to bear children. The goal is to highlight the problem of reducing fertility in women of older reproductive age. Materials and methods: medLine, Pubmed, RISC, etc. Results: analysis of literature data shows that fertility decline is determined by a combination of physiological, molecular and genetic factors that play an increasing role as we age.Conclusion: the development of modern technology can solve the problem of infertility in the vast majority of cases. However, the lack of effectiveness of assisted reproductive technologies (ART) for women over 35 years of age requires optimizing a care strategy for these women.

Objective: tto estimate the potential of the protective effect of recombinant IL-2 on the ovarian reserve of patients in advanced reproductive age after enucleation of a cystic ovarian endometriosis (COE).Materials and methods: Initially and over a year after laparoscopic ovarian cystectomy using hemostatic material based on oxidized cellulose, 63 patients with a single-sided COE (4-7 cm) were examined, age group: 36-45 years old. The levels of cytokines (IL-6, IL-2, IL-10, TNF), the content of diene conjugates of unsaturated fatty acids, malonic dialdehyde, superoxide dismutase and the level of molecules of average weight were determined in the peritoneal fluid and peripheral blood. The comparative analysis of the ovarian reserve (the antral follicle count (AFC) and the level of Anti-Mullerian hormone (AMH)) was conducted between 32 patients receiving adjuvant dienogest therapy (6 months) with additional administration of recombinant IL-2 and 31 patients receiving only dienogest.Results: When recombinant IL-2 is used in the early postoperative period, AFС (both, in the intact and operated ovary) and the AMH level (later restored to the results of the initial parameters) increase statistically significant.Conclusions: Recombinant IL-2 compensates the initial deficiency of the regulatory cytokine, reduces the proapoptotic effect on ovarian tissue, and activates antioxidant systems. When used in postoperative period of the complex therapy (IL-2 and dienogest), the ovarian reserve remains almost at the initial level, which favors the implementation of reproductive plans and reduces the likelihood of premature menopause.

Aim. To perform the efficacy analysis of abdominal birth in maternity hospitals in Krasnodar Krai based on the ratio of efficiency of caesarean section (RECS). Materials and methods. A multicenter retrospective study was conducted, which included 47 maternity hospitals of Krasnodar Krai in 2016 (number of births, the percentage of surgical activity, perinatal mortality). Calculation of the ratio of efficiency of cesarean section in each of these health institutions was made. Results. Comparative analysis of the ratio of efficiency of caesarean section has revealed the high RECS in Krasnodar Krai (an average of 8,5±0,9, p>0.05). “Bad” ratio (RECS below 1.0) met 9 health establishments of Krasnodar Krai (19,1%), “satisfactory” (RECS 1.0-1.5) - 12 hospitals and “excellent” (RECS 2,0 and above) - 26 maternity hospitals. Conclusion. The effectiveness of abdominal delivery in Krasnodar Krai is high. A detailed individualized analysis of the indications for the operative births is necessary. The most effective is the creation of diagnostic coefficients of risk factors for abdominal delivery, optimization of the routing of pregnant women with complications of gestation, extragenital pathology, premature births in hospitals of the III level, and the transition of all obstetrical institutions of the region to a unified classification of M.S. Robson, which will allow not only to give a more complete analysis of the indications for cesarean section, but also to identify ways to reduce this indicator at each obstetric hospital.

Introduction. Facial nerve paralysis disconnects person»s emotions and expression, causes lagophthalmos, disorders of taste, touch, salivation, and lymph efflux in the damaged area. Among causes of consistent facial nerve conduction defects, the most common is iatrogenic injury during extensive surgical interventions for removal of tumors of the parotid gland. Various surgery interventions are used for correction of such disorders. The article objective is to present results of performed static plastic surgeries using polypropylene thread in patients with facial nerve damage caused by radical parotidectomy.Materials and methods. From 2014 to 2016 in the Department of Microsurgery of the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, 14 patients underwent static correction using polypropylene thread to treat iatrogenic injury of the facial nerve after radical surgery for malignant and benign tumors.Results. In all patients, optimal results of repair of the esthetic component of the facial nerve were achieved. Postoperative period didn»t exceed 3 days. Effect duration is longer than 3 years.Conclusions. Use of polypropylene thread in static plastic surgery allows to perform cosmetic facial correction, eliminate gravitational ptosis and lymphostasis in patients with consistent syndrome of complete damage of facial nerve conductance.

A morphometric study of cell nuclei intact junctional zone and in patients with adenomyosis. The material for the study is based on samples amputated during queens operations (47 cases), and autopsy material from apparently healthy women (6 cases). Wiring and sealing in paraffin. Measuring the optical density was nuclei (Feulgen reaction). The diameters of the cores were used to calculate the index of nuclear symmetry. We measure the amount of amorphous and fibrous components, as well as the total amount of hypochromic and hyperchromic nuclei. It was found that in patients with adenomyosis in the area junctional zone of endometrial stromal cell nuclei are characterized by an increase in the coefficient of ellipticity and absorbance. The nuclei of smooth muscle cells show pleomorphism and increase the index of the nuclear symmetry. The formed foci of adenomyosis identified unidirectional changes. It is possible that the nuclear symmetry index and the index of the optical density of the nuclei can be interpreted as molecular predictors of oncogenic transformation.

Within our study we compared the effectiveness of laparoscopic myomectomy with bed unit closure with individual sutures and a monofilament self-locking thread. Depending on the way of the uterine wall closure during laparoscopic myomectomy 2 groups were formed among 40 women: in group I (n = 20) a monofilament synthetic thread of poliglecaprone (Monocryl Plus 0) was used by individual Z-shaped sutures; in group II (n = 20) a node-free uninterrupted suture was used with the thread with a serrated design and a fixing loop (V-lock 180 «0»). Using a node-free suture in laparoscopic myomectomy helped to reduce the duration of suturing the myometrium defect, the intraoperative blood loss, general surgical risks and the complexity of the intervention. Certain clinical benefits in using barbed suture V-lock were identified: the formation of a well-fixed uterine scar due to full recovery of the uterus anatomy after laparoscopic myomectomy while minimizing intra- and postoperative complications.

Comparative analysis of drug therapy efficacy for the syndrome of chronic pelvic pain relapses in perinatal endometriosis has been presented: it included dienogest monotherapy and combined interleukin-2 (il-2) and dienogest therapy. It has been proved that dienogest in combination with Interleukin-2 (ronkoleukin) followed by supportive therapy with dienogest-containing oral contraceptives (DCOK) is more effective for arresting pain syndrome, eliminating psycho-emotional disorders and preventing relapses.

Purpose: To research the adaptive capabilities of the female body after medical abortion.Materials and methods: 130 patients which had terminated the unwanted pregnancy by medical abortion were examined during the research. Hormonal and regulatory-adaptive status in postabortion period were evaluated. Analysis of the data was carried out taking into account the initial cycle time 23-25 days (the abortion took place at the 1 phase of cycle) and 26-32 days (the abortion took place at the 2nd phase of cycle)Results: Revealed that medical abortion provokes hormonal imbalance in the reproductive system and leads to a significant decrease in the regulatory and adaptive status, especially in patients with «short» menstrual cycles., when the abortion falls on 2 phase of the menstrual cycle. In all patients, the regulatory and adaptive status was significantly reduced. Moreover, in patients with an initial cycle time 23-25 days the reduction was significantly greater than in patients with an initial cycle of 26-32 days.Summary: Revealed that medical abortion provokes hormonal imbalance in the reproductive system and leads to a significant decrease in the regulatory and adaptive status, especially in patients with baseline menstrual cycles 23-25 days, when the abortion falls on 2 phase of the menstrual cycle.

The results of hormonal profile modification of 90 patients during early post-abortion period after medical abortion or manual vacuum aspiration were analyzed in this research. The result shows that even sparing method of abortion provokes hormonal imbalance, however the abortion that was made during the first stage of menstrual cycle gives less strain for womans reproductive system.

This study was performed to evaluate symptoms of uterine fibroid and their impact on the quality of life after treatment using a validated questionnaire. It is shown that the assessment of quality of life not only a predictor of the complicated postoperative period and the remote recurrence of a disease, as well as the criterion of full course of rehabilitation. Preference of UAE leads to sustained improvement in the quality of life and to a significant relief of symptoms with the greatest recovery after comprehensive rehabilitation.