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Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

Yu.E. Dobrokhotova1,E.I. Borovkova1, A.M. Arutyunyan1, S.Zh. Danelyan2, E.M. Malysheva2, N.V. Zharkov2,3, T.N. Aksenova2 1 Pirogov Russian National Research Medical University, Moscow, Russian Federation 2City Clinical Hospital No. 40, Moscow, Russian Federation 3 I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation Aim: to study placental vasculogenesis and angiogenesis in women receiving chemotherapy. Patients and Methods: placental structure was examined in 57 pregnant women aged 22–38 years who were subdivided into 3 groups, i.e., women with malignancies receiving or not receiving chemotherapy and healthy controls. The slices of the central part of placentas collected after childbirth were examined. Immunohistochemistry (IHC) was performed after standard histology. IHC intensity was assessed for CD31 and CD34. In addition to IHC intensity, the number of positive cells per field of view was calculated for VEGF, VEGFR1, and VEGFR2. Mean counts of positive cells separately for epithelial and stromal cells were calculated for eNOS. Results: in the control group, the maturity of the placental villous tree matched the gestational age. Meanwhile, in 100% of pregnant women with malignancies receiving chemotherapy and in 46.8% of pregnant women with malignancies not receiving chemot herapy, the maturity of the placental villous tree was 2–4 weeks behind the gestational age. IHC revealed no significant differences in the placental concentrations of CD31, CD39, eNOS, VEGF, VEGFR1, and VEGFR2 between women with malignancies not receiving chemotherapy and the controls. In women receiving chemotherapy, IHC intensity and the number of positive cells were twice as high as in the control group. The activity of VEGFR1 and VEGFR2 was 11 times higher and 1.4 times higher, respectively, than in the control group. The mean number of cells expressing VEGFR1 and VEGFR2 per field of view increased by 1.5 times and 1.7 times, respectively. In addition, 1.6-fold reduction in CD31 level and 1.3-fold reduction in CD34 level as well as 1.4-fold increase in epithelial еNOS level and 1.3-fold increase in stromal eNOS level were revealed. Conclusions: our findings on IHC distribution of the expression of VEGF and its recep-tors in the placental tissue of pregnant women undergoing cytostatic chemotherapy in part illus-trate the processes of the compensation and impaired functioning of the mother-placenta-fetus system in pre-placental hypoxia. Keywords: angiogenesis, vasculogenesis, vascular growth factor, chemotherapy, hypoxia, placental insufficiency. For citation:Yu.E. Dobrokhotova,Borovkova E.I., Arutyunyan A.M., Danelyan S.Zh. et al. Placental vasculogenesis and angiogenesis in women undergoing chemotherapy. Russian Journal of Woman and Child Health. 2021;4(1):23–30. DOI: 10.32364/2618-8430-2021-4-1-23-30.

This article is a review of publications devoted to the treatment of chronic endometritis and methods of its prevention. Methods of empiric therapy, standards of antibacterial therapy, and modern guidelines for treatment under development (colonystimulating factor, immunotherapy, amplipulse therapy) are presented. Key words: infertility, miscarriage, colony-stimulating factor, chronic endometritis, cytokine therapy

A.M. Shamilova, I.Yu. Il’ina, E.I. Borovkova, Yu.E. Dobrokhotova Pirogov Russian National Research Medical University, Moscow, Russian Federation This paper reviews an important issue that significantly affects female fertility, chronic endometritis. This condition is characterized byclinical presentations of various severity and abnormalities of endometrial morphology. The rate of chronic endometritis varies greatly, mainly due topredominantly asymptomatic course and imperfect diagnostics. Pathogenic mechanisms of endometrial inflammation and different views on its effects on female reproductive potential are addressed. Further search for endometrial receptivity markers is needed as these markers will allow for assessing the severity of endometrial damage to develop the algorithm of preconception care. The authors focus ondiagnostic techniques for chronic endometritis and their value. Immunohistochemistry of endometrium is a promising tool to be applied to diagnose endometrial inflammation and monitor treatment efficacy. A complex diagnostic approach to chronic endometritis that includes pelvic ultrasound, 20 Doppler ultrasound, assessment of endometrial microbiota, diagnostic hysteroscopy and endometrial histopathology, andevaluation of endometrial receptivity is useful. Keywords: chronic endometritis, termination of pregnancy, infertility, autoimmune processes, chronic inflammation, endometrial structure, immunohistochemistry. For citation: Shamilova A.M., Il’ina I.Yu., Borovkova E.I., Dobrokhotova Yu.E. Chronic endometritis. Towards the improvement of diagnostic methods. Russian Journal of Woman and Child Health. 2021;4(3):243–249 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-243-249.

Objective. To study the effectiveness of the use of Acilact Duo for relieving the symptoms of atrophic vaginitis against the background of antiestrogen therapy. Patients and methods. The study included patients of reproductive age (n = 21) who were treated with goserelin (10.8 mg once every 3 months) in combination with tamoxifen (20 mg per day) for previously diagnosed breast cancer (luminal A type). Inclusion criteria were: age 28–45 years, complaints of vaginal dryness and micro-cuts, dyspareunia, breast cancer in anamnesis. Microscopic and bacteriological examination of the vaginal discharge was carried out. Patients filled out an individual questionnaire on the symptoms of atrophic vaginitis and dynamics of psycho-emotional state according to the Spielberger–Khanin scale. Results. The most common patients’ complaints were: dryness (up to 6.1 points) and the presence of vaginal micro-cuts (1.5 points), dyspareunia (1.3 points). After the course of treatment with Acilact Duo, the severity of symptoms decreased by 1.5 times. The assessment of psychological status demonstrated a low subjective evaluation of health and quality of life (36.7 ± 1.4 points). Twelve days after treatment, a mean anxiety score improved and amounted to 30.9 ± 0.6 points (р < 0.05). The intensity of vaginal microbial colonization in atrophic vaginitis is low and characterized by the absence of lactoflora and the predominance of enterobacteriaceae, atopobium vaginae, staphylococci, streptococci and peptostreptococci. After local therapy with Acilact Duo, there was an increase in colonization by lactobacilli (by 5.1 times, р < 0.05), a decrease in the level of colonization by streptococci (by 1.7 times, р < 0.05), staphylococci (by 2 times, р < 0.05), peptostreptococci (by 4.3 times, р < 0.05) and enterobacteriaceae (by 4 times, р < 0.05). Conclusion. A short 10-day course of treatment with Acilact Duo for patients with atrophic vaginitis can significantly reduce the severity of symptoms and improve the quality of life of women of reproductive age. Key words: atrophic vaginitis, genitourinary syndrome, lactobacilli, dyspareunia, breast cancer

Chronic endometritis is a clinical morphological syndrome that develops as a result of a self-sustaining pathological process, which is based on a violation of the production of pro-inflammatory cytokines initiated by an infectious factor. The article presents the clinical and etiological classification of endometritis, the pathogenesis of development in terms of involvement of immunocompetent cells, standards for diagnosis and therapy.

Hydatidiform mole (HM) is a disease of trophoblast tissue with saved proliferative potential and it develops after aberrant fertilization. Complete HM is characterized by a rapid increase in a size of the uterus, a significant increase in human b-chorionic gonadotropin (hCG), bleeding, symptoms of hyperthyroidism, severe vomiting of pregnant, and early preeclampsia. Thecalutein cysts are formed in the ovaries as a result of exposure to high titers of hCG and prolactin. Multiple pregnancy may be complicated by the development of complete and partial HM in one of the fetuses in one case for 20 000-100 000 pregnancies. The article presents a clinical case of pregnancy care of a 32-year-old woman with dichorial biamniotic twins and a complete HM of one fetus. Pregnancy occurred spontaneously, proceeded with threatening miscarriage up to 12 weeks, threatened preterm labor, pre-eclampsia from 24 weeks. The patient underwent induction of labor at 28 weeks due to severe pre-eclampsia, a live premature girl with a weight of 1030 g weight, height of 33 cm tall and Apgar score of 6/7 points was born. On the 40th day after birth, b-hCG level was negative.

Yu.E. Dobrokhotova, E.I.Borovkova, T.D.Simonyan, D.S.Selimshaeva Pirogov Russian National Research Medical University, Moscow, Russian Federation Aim: to evaluate the clinical efficacy of dietary fibers and lactulose in pregnant women with large bowel obstruction. Patients and Methods: this prospective study included 60 pregnant women (20–24 weeks of pregnancy) with large bowel obstruction occurred during pregnancy and persisted for at least 3 months. All women were randomized and divided into two groups. Group 1 received soluble fibers and group 2 received group 2 received lactulose. Clinical efficacy of treatment was evaluated using a specialized questionnaire filled at baseline, 48 h, 4 days, and 14 days after starting treatment. Results: mean age was 27.1±4.0 years in group 1 and 28.3±5.0 years in group 2. Bowel evacuation less than 3 times a week occurred in 87% and 77%, respectively, the duration of pushing occupied more than 25% of defecation in 70% and 60%, respectively, hard stool occurred in 100%, anal fissures and a feeling of incomplete evacuation were reported in 47% and 57%, respectively. Comfort bowel evacuation 48 h after starting treatment was reported in 63% of women who received dietary fibers and 47% of patients who received lactulose. Normal defecation by day 4 was observed in 80% of women in group 1 and 53% in group 2. Treatment effect was achieved by day 14 in 87% in group 1 and 70% in group 2. The most common complaint was abdominal distension that occurred 3.5 times more common after treatment with lactulose (р Conclusions: dietary fibers were more effective in terms of achieving the desired outcome and patient satisfaction. Keywords: large bowel obstruction, defecation, pregnancy, dietary fibers, OptiFibere, lactulose. For citation: Dobrokhotova Yu.E., Borovkova E.I., Simonyan T.D., Selimshaeva D.S. Large bowel obstruction during pregnancy: the efficacy of dietary fibers. Russian Journal of Woman and Child Health. 2021;4(1):36–41. DOI: 10.32364/2618-8430-2021-4-1-36-41.

Background. Vitamin D is an essential component that regulates calcium homeostasis and many other cellular functions. Hypovitaminosis D is associated with a risk of osteopenia, obesity, type 1 and type 2 diabetes, malignant neoplasms and immune disorders. Inadequate vitamin D intake during pregnancy increases a risk of pre-eclampsia, preterm birth, low birth weight as well as it has a negative impact on both children’s and adolescents’ health. It is important for the clinician to be known administrating of vitamin D prophylactic and therapeutic regimens according to serum 25(OH)D levels. Aim. To determine causes and effects of vitamin D deficiency and to elaborate ways of their correction. Materials and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-15 years was conducted. The review includes articles from peer-reviewed literature. Results. The article shows that vitamin D has a significant impact on both the cardiovascular, endocrine, digestive, respiratory and other systems functioning and perinatal outcomes that necessitates vitamin D deficiency correction. It provides schemes for effective therapeutic and prophylactic drug doses calculating depending on vitamin D3 blood serum concentration. Conclusion. Preference should be given to cholecalciferol (vitamin D3) due to its better absorption properties and more efficient conversion to active vitamin metabolites (class IIC).

During the first 4 weeks of gestation, the embryo is not yet differentiated and exposure to chemotherapy occurs the all-or-nothing principle. Most vulnerable to chemotherapy is the period from 5 to 10 weeks of pregnancy, the use of 1 cytostatic increases the risk of malformations in the hearth up to 10%, and a few - up to 25%. Prescription of therapy after 12 weeks is not associated with the risk of malformations. Development, but leads to delayed growth of the fetus and pancytopenia in newborns in 30%. Probability of a metostatic lesion the placenta and fetus is extremely low and is described primarily for hematogenous tumors. The course of treatment must be completed in 3 weeks. Before giving birth.

The article presents the algorithms of patient management, depending on the results of smear on oncology and in accordance with the age of the patient.

Heart rate variability values are potentially important for assessing vegetative dysfunction in children.The purpose of the research: a comparative study of spectral heart rate variability parameters and synchronization of low-frequency oscillations, characterizing baroreflex in the vegetative regulation of the cardiovascular system in healthy newborns and adults.15 healthy newborns and 60 healthy individuals in the age of 18-34 years old were included in the study. We performed synchronous recording of electrocardiograms and photoplethysmograms with 10 minutes duration, at rest. Were evaluated spectral heart rate variability indices and the index of synchronization of low-frequency oscillations in heart rate variability and photoplethysmograms (S index).Results. In newborns, the peak of low-frequency oscillations was predominantly in the range 0.07–0.09 Hz, and high frequency 0.40–0.50 Hz. Newborns had lower LF% values than adults: 22.8 (14.1, 29.4) vs 32.9 (25.1, 41.9) (p=0.009). The S index in newborns was 20.1 (16.9, 26.5)%, and 33.2 (21.2, 45.4)% in healthy adults (p=0.023).Conclusion. We have first demonstrated that the interaction of baroreflex regulation of heart rhythm and peripheral blood filling in healthy newborns is characterized by lower values of S index, than in healthy adults, which can be explained by the immaturity of the vegetative regulatory elements of the cardiovascular system.

Progesterone-containing contraceptives do not have a significant impact on metabolic processes and can be prescribed to patients with systemic (diabetes mellitus, obesity) and other diseases. Desogestrel is a part of oral preparations in a dose of 75 mcg. The main mechanism of its contraceptive action is Suppression of ovulation (in 97% of cases). The frequency of pregnancy is 0.17 for 100 women-years. Progesterone-containing contraceptives should not be considered, as preparations of the second choice when deciding on the issue of family planning. According to the recommendations of the Center for Disease Control and Prevention organization of health, desogestrel is an acceptable contraceptive option for women with somatic diseases, defined tumor pathology and thrombotic states in the anamnesis.

The article is devoted to diagnostic methods, therapy possibilities and algorithms of management of patients with cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis is only valid during pregnancy. Shortening the length of the cervix

The article summarizes the results of numerous randomized studies and structured the approach to the tactics of managing patients with primary dysmenorrhea. The starting therapy is the administration of non-steroidal anti-inflammatory drugs and/or estrogen-progestational drugs. In the absence of the effect of therapy for 3 months, it is advisable to switch to a drug of another group or a combination of drugs. Failure to achieve the desired therapeutic result within 6 months is the basis for clarifying the diagnosis. The article is illustrated by the clinical case of a patient with primary dysmenorrhea.

Associated with pregnancy is breast cancer, which was first detected during pregnancy, during the first year after childbirth or at any time against lactation. Diagnosis of the disease in the first trimester is an indication for abortion. The detection of the disease after 20 weeks and the desire of the woman to maintain pregnancy is the basis for conducting a total mastectomy followed by polychemotherapy with doxorubicin with cyclophosphamide or with fluorouracil. Radiation therapy during pregnancy is not applied. The timing and method of delivery are determined individually and depend on the stage of the process and the period of pregnancy, when it was identified. A clinical case of a patient with edematous-infiltrative form of breast cancer of the IV stage, diagnosed for the first time in 22 weeks of pregnancy, is presented.

Genital herpes is a common disease diagnosed in 90% of people and is characterized by a recurring lifelong course. Clinical manifestations are diverse and manifest in 20% of infected people. The gold standard for diagnosis is the detection of virus culture and polymerase chain reaction in real time. Conducting oral antiviral therapy significantly reduces the duration, severity of the disease and the risk of infection of the sexual partner. At the initial episode of genital herpes it is necessary to carry out system antiviral therapy with its earliest start. The effectiveness of the use of acyclovir, valaciclovir and famciclovir is comparable, but only with valaciclovir the efficacy of two-fold daily dosing is proved. For patients with 6 or more episodes of exacerbations per year, suppressive therapy is indicated, the drug of choice is valaciclovir. With a relapse rate of less than 6 per year, it is sufficient to conduct episodic antiviral therapy. Clinical trials have demonstrated comparable efficacy of acyclovir, famciclovir and valaciclovir. The three-day course of valaciclovir (500 mg 2 times a day) is most suitable in view of the high bioavailability and rapid relief of viremia.

Connective tissue dysplasia is a genetically determined condition characterized by a violation of the structural organization and synthesis of the main components of connective tissue. The prevalence of non-syndromic forms is extremely high and to 46.6-72.0% is due to cofactor deficiency of magnesium. Typical obstetric complications in Ehlers-Danlos syndrome are bleeding, early formation of isthmicocervical insufficiciency, premature and rapid delivery, delayed fetal growth, symphysiopathy, rupture of the pubic joint, rupture of the perineum, spontaneous ruptures of the skin, vagina and internal organs, postpartum bleeding and incompetence of the pelvic floor muscles, bladder, urethra and rectum. Marfan syndrome in 40% of cases develop premature rupture of membranes, premature birth and miscarriage at an early age. Maternal mortality is 0.74 per 100 000 births and is associated with lamination (1%) or rupture of the aortic aneurysm (3%). With nonsynthetic forms of connective tissue dysplasia at the stage of pregravid preparation and throughout pregnancy, the appointment of magnesium preparations is indicated.

The prevalence and detection rate of tumors associated with pregnancy, is growing steadily. Detection of malignant neoplasms has always put the doctor before the need for a decision about the possibility and desirability of pregnancy. The fundamental issue is the nature and stage of pathologic process and duration of pregnancy. According to the Ministry of health and social development of the Russian Federation from December 3, 2007 N736 "On approval of the list of medical indications for artificial interruption of pregnancy", in the case of neoplasms that require chemotherapy or radiotherapy to the pelvic area when the code of the disease C51-58, shows the termination of pregnancy. In all other cases, the question of abortion is solved individually by the doctors. The article presents clinical cases of medical termination of pregnancy in patients with gestational age up to 20 weeks.

The article presents a literature review on methods of diagnosis, therapy and management of patients with isthmic-cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis can be made only during pregnancy. Shortening of cervical length

The aim of the study was to determine the frequency of occurrence of group B Streptococcus in women in labour and newborn babies. Materials and methods. prospective study included two groups: group 1 patients (n=35) with full-term pregnancy and term birth, group 2 patients (n=22) with preterm birth in the period from 34 to 37 weeks. All patients upon admission and all newborns was carried out rapid test for Streptococcus group B. Results. in the 1st group, the test was positive in 25.7% of women and 8.6% of newborns. In the 2nd group, the test was positive in 18.2% of women and 22.7% of newborns.a prospective study was conducted of contamination of the genital tract in pregnancy Streptococcus group B. We have formed 2 groups: group 1 patients (n=35) with full-term pregnancy and term birth, group 2 (n=22) patients with preterm birth in the period from 34 to 37 weeks. All patients upon admission and all newborns was conducted rapid test for Streptococcus group B. In the 1st group, the test was positive in 25.7% of women and 8.6% of newborns. In the 2nd group, the test was positive in 18.2% of women and 22.7% of newborns.

Review of the literature devoted to the problem of early pregnancy losses. Presented modern classification, The etiology and pathogenesis of complications, diagnostic criteria and differential diagnosis, and treatment standards and opportunities for prevention.

The study allowed to compare the clinical efficacy of the drug and antibiotic Terzhinan gynecological patients operated on for tubal peritoneal factor infertility. In women receiving traditional intraoperative antibiotic prophylaxis, the antimycotic treatment followed 2 weeks; after surgery the violation of the qualitative and quantitative composition of the microflora of the vagina was observed, which further required additional therapy. In patients who used Terzhinan, dysbiotic violations in the vagina were observed only in 2 women was a decrease in the number of representatives of the indigenous microflora. Thus, the local use of antibacterial drugs in the perioperative period can be considered as an alternative to the system or the single use of antibiotics, which allows to recommend their use in order to reduce the incidence of inflammatory and infectious diseases of the vagina in gynecological patients before and after surgery.

The following review is devoted to the problem of early pregnancy loss, the etiology and pathogenesis of this complication.

The aim of the study was to investigate the effects of topical application of preparations containing glucocorticoids on the replicative activity of human papillomavirus oncogenic type. Prospective study included 160 patients of reproductive age. The examination included microbiological testing, qualitative and quantitative screening for human papilloma virus high-risk group (HPV-PCR and Digene-test), immunological study of cervical secret (immunoglobulins class A, M, G and secretory IgA). Was shown that the vaginal microbiocenosis in patients with nonspecific vaginitis presents a wide range of opportunistic microorganisms, such as Staphylococcus, Streptococcus, Peptostreptococcus, Bacteroides, Bacillus, Actinomyces, Corynebacterium, Prevotella. A number of typical representatives of the indigenous microflora is significantly reduced, or absent. The prevalence of concomitant viral infection was approximately 29%, the most frequently detected viruses 16, 31 and 18. The use of local therapy drug containing a glucocorticoid qualitative and quantitative changes in HPV have been no identified. Evaluation of indicators of local immunity showed an imbalance in the production of immunoglobulins with a predominance of IgA, secretory IgA and IgG in patients on the background of nonspecific vaginitis.

The article presents current data on ovarian hyperstimulation syndrome. Classification, criteria for assessing the severity and in algorithmic form, see diagnostic and treat-ment approach to patients management. Separately theis sues of prevention of thromboembolic complications.

This article provides information on acromegaly, highlighting the diagnostic algorithm of search and therapeutic tactics in detecting the disease in women of reproductive age. Based on the above clinical case described medical tactics in the management of pregnant women with acromegaly.

The article presents a review of international literature on the possibilities of prevention of pre-eclampsia in women at high risk. Given data from recent randomized trials and meta-analyses, have confirmed whether the use of low-dose antiplatelet therapy with 12 weeks of pregnancy to prevent the development of pre-eclampsia.