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Introduction. Epispadias is an extremely rare disease. Epispadias in women is 5–6 times less common than in men. The incidence of female epispadias ranges from 1 in 160,000 to 480,000 live births. Epispadias can be diagnosed by a thorough examination of the genitals. Treatment of epispadias is only surgical, which is quite difficult and requires experience. The literature that discusses female epispadias is very limited. In this article, we would like to report on the surgical treatment of isolated epispadias in a 3-year-old girl at the Almazov National Medical Research Center.Clinical case. A 3-year-old girl presented with the main complaint of urinary incontinence since birth, during the day and at night. Urinary incontinence was not caused by physical activity and was not aggravated by eating/drinking. Physical examination showed that the external genital organs of the patient have underdeveloped labia minora, abnormal urethra, bifurcated clitoris. Laboratory results were within the normal range. Voiding cystourethrography revealed urine leakage during the filling phase. The bladder wall was normal, there was no vesicoureteral reflux. The patient underwent simultaneous surgical interventions, consisting in plastic surgery of the urethra and reconstruction of the bladder neck, plastic surgery of the clitoris and labia minora. There were no intraoperative and postoperative complications. After 1 week and 6 months of observation, the patient achieved urinary retention, the surgical wound healed primarily.Discussion. Epispadias is a rare condition that can vary in severity from mild to severe. Severely, splitting of the entire urethra occurs, involving the bladder neck, causing permanent urinary incontinence in the patient. Cases of epispadias are quite difficult to diagnose. The doctor should dilute the labia majora and carefully conduct a physical examination. The objective goals of the surgical treatment of epispadias are to achieve urinary retention, restore the anatomy, function and cosmetic appearance of the urethra and genitals. One-stage reconstruction is a modern surgical technique used to treat isolated epispadias in women.Conclusion. Epispadias in women is a rare congenital anomaly that is often not detected in childhood. For isolated epispadias in a girl, one-stage surgical correction is currently preferred.

Gestational trophoblastic disease (GTD) is a rare tumor characterized by spectrum of trophoblastic proliferative disorders associated with pregnancy. These neoplasms occur in less than 1% of female genital malignancies. There is a high curability of the disease even in the presence of disseminated process with the ability to preserve reproductive function. However, this is possible if timely diagnosis and adequate treatment tactics were applied. The article presents a review of the literature and the summary of guidelines of treatment of this malignancy.

Altered pelvic venous circulation, which may occur due to pelvic venous congestion and varicose veins of the vulva, may be among the causes for developing chronic pelvic pain syndrome. Pelvic congestion syndrome (PCS) is characterized by chronic discomfort in the pelvic area, which may be aggravated during coitus or acquire orthostatic position, and result in severe dysfunction of the pelvic organs. Varicose veins of the vulva develop due to obstruction of the veins, increased venous pressure, and venous insufficiency in the pelvis. Varicose veins may be isolated or associated with varicose veins of the lower extremities. The diagnosis and treatment of such patients are limited by the lack of definitive clinical criteria for early diagnostics, which were discussed in the current study.

The article is devoted to the historical aspects of the emergence and development of methods of radiology diagnostics in perinatology — a science that studies the perinatal period and is at the junction of two disciplines: obstetrics and pediatrics. The official recognition of perinatal medicine as an independent direction took place in economically developed countries in 1976 (8 years after the first Congress on Perinatology), when the European Scientific Society of Perinatology was created. One of the most important tasks of perinatology is to assess the condition of the fetus and extrafetal structures, which include the placenta, umbilical cord, fetal membranes. As part of the development of perinatology, new areas of medical science have arisen and continue to actively develop, including radiology diagnostics in perinatology. Currently, during pregnancy, from radiology diagnostic methods, ultrasound and magnetic resonance imaging are safe and informative. The emergence and development of classical X-ray diagnostics is considered separately in the article. Attention is drawn to the current state of the methods of radiology diagnostics when used in perinatology, the order of appointment, indications and contraindications, advantages and disadvantages. The study of the history of the development of radiology imaging in perinatology makes it possible to trace the dynamics of the development of this industry, to analyze the stages of the formation of instrumental research methods during pregnancy. Thanks to the constant development of technology, a large amount of accumulated experience in radiology imaging during pregnancy, the creation of international communities for diagnostics in perinatology and the formation of interdisciplinary approaches for the management of pregnancy, it has become possible to quickly, safely and non-invasively receive information about the condition of a pregnant woman and a fetus.

Endometriosis of the anterior abdominal wall is a rare disease comprising 0.3–3.5 %. In turn, its diagnosis is quite challenging due to the nonspecific picture, including pain in the anterior abdominal wall during menstruation. Upon clinical examination, a thickened area may be observed in the anterior abdominal wall, usually in the area of tissue involved in surgery. Ultrasound examination is a simple, economical, and reliable method of choice to diagnose extragenital endometriosis. Here we describe a case report of the patient after surgery of anterior abdominal endometriosis localized in the rectus abdominis muscle in the umbilical region and confirmed by ultrasound test and morphological examination of excised macroscopic sample.

Introduction. Perinatal mortality in multiple pregnancies increases by 8–10 times compared to singletons. Stillbirth is a significant part of all complications of multiple pregnancies. Although the incidence of perinatal mortality in multiple pregnancies has decreased consistently compared to extremely high rates in the past, it remains relatively high, despite significant positive changes in the management of such pregnancies. Aim: to assess the diagnostic potential of the first trimester's biochemical screening in multiple pregnancies for predicting antenatal fetal death. Materials and Methods. As part of a retrospective study, a cohort of twin pregnancies after in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or spontaneous conception underwent screening of the first trimester at 11+0–13+6 weeks of gestation as recommended by the Fetal Medicine Foundation. Determination of pregnancy-associated plasma protein-A (PAPP-A) in blood serum with subsequent calculation of the relative PAPP-A MoM (multiples of median) – a multiple of the median (an indicator of how much the individual test result deviates from the reference values) was performed. Results. Prenatal screening and outcomes of 302 multiple pregnancies showed that with PAPP-A MoM < 0.5, antenatal fetal death occurred with a frequency of 42.86 % (6/14), with PAPP-A MoM within the reference values – In 12.67 % (28/221), with PAPP-A MoM > 2.0 – in 6.7 % (2/30). Differences between patients with PAPP-A MoM < 0.5 and PAPP-A MoM within the reference values, as well as PAPP-A MoM < 0.5 and PAPP-A MoM > 2.0 were statistically significant (p = 0.002 and p = 0.004, respectively). No differences were detected between spontaneous and assisted reproductive technology (ART) pregnancies. Conclusion. In women with multiple pregnancies resulting from ART or spontaneous, PAPP-A MoM values below the reference interval (< 0.5) in the first trimester are associated with an increased risk of antenatal fetal death.

Omic-technologies (genomics, transcriptomics, proteomics and metabolomics) have become more important in current medical science. Among them, it is metabolomics that most accurately reflects the minor changes in body functioning, as it focuses on metabolome – the group of the metabolism products, both intermediate and end. Therefore, metabolomics is actively engaged in fundamental and clinical studies and search for potential biomarkers. The biomarker could be used in diagnostics, management and stratification of the patients, as well as in prognosing the outcomes. The good example is gynecology, since many gynecological diseases lack effective biomarkers. In the current review, we aimed to summarize the results of the studies, devoted to the search of potential metabolomic biomarkers for the most common gynecological diseases.

Introduction. Serum proteins PAPP-A (pregnancy-associated plasma protein-A) and β-hCG (the в-subunit of human chorionic gonadotropin) levels are components of the 1st trimester combined screening aimed to detect fetal aneuploidies. In contrast to singleton pregnancies, where the values are well established, this is not the case in twins. Aim : a comparative analysis of serum proteins PAPP-A and β-hCG levels, as well as parameters PAPP-A MoM and β-hCG MoM in the first trimester during pregnancy with dichorionic diamniotic twins that occurred spontaneously or as a result of in vitro fertilization (IVF). Materials and methods . The study group included multiple pregnancies as a result of IVF procedure (n = 100) and spontaneous multiple pregnancies (n = 121) considered as controls. The levels of PAPP-A, β-hCG, PAPP-A MoM and β-hCG MoM were compared using nonparametric Mann-Whitney U test. Results. The PAPP-A MoM level resulted higher in the group of IVF twins (p = 0,007) compared to spontaneous twins: 1.28 [0.97; 1.89] vs. 1.12 [0.87; 1.40] (median [interquartile range]). There were no statistically significant differences in в-hCG levels between the groups of IVF twins and spontaneous twins. Conclusion. The results justify the need for further study of PAPP-A and β-hCG to establish their association with adverse outcomes in both groups of multiple pregnancies.

The rapid spread of COVID-19 and the large number of cases put a significant burden on the health systems of any developed country. Specialists in natural disasters and military medicine should be involved in the provision of medical care and observance of anti-epidemic measures. In some countries, including Italy, they were involved only after the situation was dramatically worsening with many clinical units and hospitals overloaded by infected patients. To curb the spread of COVID-19, most countries declared a state of emergency, and unprecedented measures have been taken to strengthen quarantine in suspected or positive symptomatic subjects. Nevertheless, the crisis associated with the unexpectedly global scale and tragedy of the pandemic and the inconsistency of actions of both society and individuals and specialized medical services, lead to insufficient effectiveness of the measures taken in a number of regions. In the present day, it is vital for every person to change its mindset ― relying on personal responsibility to comply with all recommendations of quarantine and anti-epidemic measures, and to reorganize departments and resources of medical institutions at all levels in order to withstand the spread of infection and at the same time provide all those in need with the necessary and appropriate medical care. Particular attention should be paid to the obstetric care service, given that even in normal times, the obstetric hospital is an area of increased responsibility for the life and health of mother and child and future mankind. Fulfillment of existing orders, instructions of national and regional committees, international and national protocols and clinical protocols should undoubtedly lead to a positive result, but this requires additional training of medical personnel at all levels. The purpose of this review is to propose quick key strategies for reassessing the maternity and neonatal wards/ hospitals based on the experience of health systems and organizations which faced the spread of this new coronavirus; this advice may be applied along with binding tight instructions in obstetric hospitals in order to proactively respond to a likely wave of growth in COVID-19.

In this study we are developing predictive models for a length of stay after a gynecological surgery, complications and the length of the surgery using machine learning methods. The study was performed with the data of patients with the diseases of the female reproductive system. The patients were admitted to the Almazov National Medical Research Centre (Saint-Petersburg, Russia) within the period 2010-2020. The study included 8170 electronic medical records of inpatient episodes including 3500 operation protocols. The data included anamnesis of life, anamnesis of disease, laboratory tests, severity, outcome of a surgery, main and comorbid diagnosis, complications, case outcome. The dataset was randomly split into 70% train and 30% test datasets. Validation with the test dataset provided the following prediction metrics for the length of stay after a surgery model. Training score: AUC of ROC: 0.9582230976834093; K-fold CV average score: -8.73; MSE: 5.65; RMSE: 2.83.

In children with cancer, the issues related to the quality of life are becoming increasingly important together with the improvement of survival rates. This creates an entirely new challenge - minimizing the toxicity of the antitumor therapy without reducing its effectiveness. One of the specific side effects of the antitumor therapy is gonadotoxicity, which negatively affects both the somatic and mental state of the survivors. Since ovarian stimulation is ineffective in prepubertal patients, ovarian tissue cryopreservation (OTC) remains the most promising option to preserve fertility. The primary goal of this publication is to emphasize the importance of the reproductive health problem in girls with oncological diseases, with a description of the current data of international literature on the prospects of OTC in order to preserve fertility. Another goal is to present a multidisciplinary strategy for the management of prepubertal age patients with the oncological disease within the framework of the Oncological Fertility Project at Almazov National Medical Research Center. Based on the data of Russian and international literature, as well as existing guidelines and recommendations on reproductive health, a single algorithm for selecting patients has been developed, considering the expected gonadal toxicity for the use of the OTC in prepubertal girls. The developed algorithm allows identifying patients of prepubertal age, requiring the use of new possibilities of reproductive technologies. In a long-term date, we are planning to evaluate the effectiveness of the orthotopic reimplantation technique of the cryopreserved ovarian tissue in restoring the reproductive function. A multidisciplinary team of specialists and the possibilities of the Federal Center facilitate implementing the Oncofertility Program in routine practice for girls and young women, receiving gonadotoxic treatment.

The application of the 3D printing approach in medicine is currently becoming increasingly popular. The management of fetuses and newborns with congenital heart defects is often difficult, primarily due to the complexity of the anatomy. Here we report a newborn with a complex congenital malformation (absent pulmonary valve syndrome associated with tetralogy of Fallot), which could be clinically interpreted in different ways. 3D printing allowed to elucidate the exact anatomy more precisely and direct the cardiosurgeon to a definitive treatment.

Telemedicine is a promising direction in the development of medical technologies for the interaction of patients with doctors at a distance. In this paper, we consider the use of telemedicine technologies for the development of smart medical autonomous technology. An example of a smart medical autonomous distributed system for diagnostics is also discussed. To develop this system for medical image analysis we review several processing methods and machine learning algorithms. Some examples of medical system processing results are presented.

IntroductionVWD-affected females often experience menorrhagia. Periodical fluctuations of the sex steroids during the menstrual cycle cause changes both in the coagulation and immune system. The aim of the current study was to assess the changes in selected inflammatory and endothelial markers in women with VWD during two phases of the menstrual cycle (follicular and luteal) and to compare it with corresponding data from healthy controls.Materials and methodsThe study group included 12 VWD-affected females with regular menstrual cycle, with none of them being prescribed hormone treatment. They were not pregnant or breastfeeding. The control group consisted of 102 healthy females, matched for age and BMI.ResultsWithin the VWD group, endostatin was higher during the follicular phase, compared to the luteal phase, although the difference was not significant (p = 0.062). sICAM-1 and IL-6 were higher in VWD-affected females, compared to the controls, sVCAM-1, cathepsin S and sP-selectin were lower (pConclusionsHigher levels of endostatin during early follicular phase could potentially predispose women with VWD to the development of heavy menstrual bleeding, due to antiangiogenic properties and ability to suppress several coagulation factors. Lower p-selectin levels in VWD group, compared to controls, may also contribute to the bleeding tendency. Changes in other proteins, involved in angiogenesis are hypothetically related to the formation of angiodysplasia-common complication of VWF deficiency. The latter statement requires confirmation in larger studies.

Endometriosis is a chronic, progressive, relapsing estrogen-dependent disorder characterized by the growth of tissue structure and function similar to the endometrium outside the normal mucosa of the uterine cavity localization. Endometriosis is found in 10–15% of women in reproductive age and it is one of the main causes of pelvic pain syndrome and infertility. Mechanisms of the development of endometriosis and related pathological pain impulses are still poorly understood and therapeutic approaches do not always have a sufficient effect; in this connection, the study of the pathogenesis of endometriosis and endometriosis-associated pain currently is perspective. Identification of significant factors of angiogenesis, lymphangiogenesis, and neurogenesis in the external genital endometriosis will promote the development of non-invasive early diagnosis and pathogenetic therapy.

Fluctuations of the sex steroids during the menstrual cycle might significantly influence hemostasis. This association, derived from a number of the observations on healthy women, is yet to be described in females affected by bleeding disorders. The aim of the current study was to assess the changes in hemostatic variables in women with vWD during two phases of the menstrual cycle (follicular and luteal) and to compare it with healthy controls. The study group included 12 vWD-affected females with regular menstrual cycle, with none of them being prescribed any hormonal treatment. The control group consisted of 102 healthy females, matched for age and BMI. Within the vWD group FVIII and FX were both significantly higher during follicular phase than in luteal phase (p = 0.013 and p = 0.033 respectively). AT, FII, FVII and FX were higher in women with vWD, compared with controls during both phases of the menstrual cycle (p

The presence of pathological alleles of single nucleotide polymorphisms (SNP) of the folic acid cycle genes is one of the female reproductive system violation factors including habitual miscarriage and pre-eclampsia. The realizing mechanism for this genetic predisposition is hyperhomocysteinemia-homocysteine level increasing in the blood. This study presenting an attempt to find the relationship between the genotype for the four SNPs of the three folate cycle genes - C677T and A1298C of the MTHFR gene, A2756G of the MTR gene and the A66G of the MTRR gene and the homocysteine level in the blood of women with impaired pregnancy. As a result no direct correlation was found but it was found a statistically significant interlation between the presence of pathological alleles of the studied SNP and the mean square deviation (σ) of the homocysteine level fluctuations over time. For the polymorphism C677T of the MTHFR gene σ of the homocysteine blood level fluctuation is increased up to four times in women with a homozygous pathological state TT compared with the normal homozygotes CC. The clinical importance of monitoring the homocysteine blood level has been shown especially for women with folate cycle genes pathological alleles’ presence.

Nowadays, the reproductive medicine has started to develop precipitously. Nevertheless, 60 to 80 millions of couples worldwide suffer from infertility. The etiology and pathogenesis of many disease...

Currently the significant part of reproductive disorders such as refractory pregnancy loss (RPL), infertility, unsuccessful in vitro fertilization (IVF) are thought to be connected with different genetic factors. One of the main hereditary risk factors for obstetrical pathology development is the presence of polymorph alleles in several genes of folic acid cycle. The present study is dedicated to investigation of the effect of folic acid cycle polymorph variants MTHFR C677 T, MTR A2756G and MTRR A66G on the RPL development and unsuccessful IVF. The samples of peripheral blood of 138 women were tested and showed a statistically significant increase of pathologic genetic alleles of MTRR A66G and MTHFR C677T frequency in two groups of patients with reproductive disorders, i.e. RPL and IVF, versus the control group. Also the advantage of simultaneous analysis of three folic cycle genetic polymorphisms at once in women with reproductive function disorder was demonstrated in comparison with the analysis...

To review the literature and to present the latest advances in the autotransplantation of cryopreserved ovarian tissue.A literature review was conducted for all relevant articles assessing the fertility preservation, ovarian tissue transplantation, standard freezing and vitrification of ovarian tissue.One of the promising and effective methods for fertility preservation may be the autotransplantation of cryopreserved ovarian tissue. At present, 30 babies have been born after orthotopic autotransplantation of frozen-thawed human ovarian tissue. Restoration of ovarian activity occurs between 3.5 months and 6.5 months. The longevity of autotransplanted ovarian tissue is about 5-7 years. The follicles are similarly preserved after all freezing methods; however, the ovarian stroma is significantly better preserved after vitrification than after slow freezing. An important topic for further research is preparation of the "vascular bed", optimization of vitrification technique and the development of alternative procedures to avoid the transmission of cancer cells via ovarian tissue autotransplantation - "artificial ovary".Cryopreservation of ovarian tissue has unique advantages over other strategies. This method: (1) does not delay cancer treatment; (2) is safer for hormone dependent malignancy; (3) can be done independent of menstrual cycles; (4) is the only option for prepubertal girls; (5) can restore not only fertility but endocrine function.

This article is dedicated to the surgeon A. A. Keeter (1813 -1879). He was one of the prominent students of N. I. Pirogov. He made a significant contribution to the science and clinical medicine. A. A. Keeter popularized new surgical techniques in gynecology and was the head of the first gynecological clinic in Russia. This clinic was opened in 1842 in Saint Petersburg State Medical Surgical Academy. He published the first detailed manual “Gynecologic diseases guidelines” in 1858. Moreover A.A. Keeter was the first surgeon in Russia who performed vaginal hysterectomy with successful result. Keeter was an outstanding scientist and founder of Russian surgical school.

Three case reports of patients with chronic pelvic pain caused rare pathology described in this article. Diagnostic algorithm, results of examination, laparoscopic findings were shown. These case reports may be interesting for gynecologists, pathologists, anesthesiologists.

Main principles of endoscopic image processing are considered. Specific characteristics of such images and complexities in their classification are discussed. We suggest that several features may be regarded as specific signs that can be used to discriminate between benign and malignant loci. The methods of colour histograms, gradients and texture analysis are considered and discussed.

At present, the patient preparation for IVF needs to undergo a series of planned tests, including the genotyping of single nucleotide polymorphism (SNP) alleles of some genes. In former USSR countries, such investigation was not included in overwhelming majority of health insurance programs and paid by patient. In common, there are prerequisites to the study of more than 50 polymorphisms. An important faced task is to determine the optimal panel for SNP genotyping in terms of price/number of SNP.During 2009-2015 in the University Hospital of St. Petersburg State University, blood samples were analyzed from 550 women with different reproductive system disorders preparing for IVF and 46 healthy women in control group. In total, 28 SNP were analyzed in the genes of thrombophilia factors, folic acid cycle, detoxification system, and the renin-angiotensin system. The method used was real-time PCR.A significant increase in the frequency of pathological alleles of some polymorphisms in patients with habitual failure of IVF was shown, compared with the control group. As a result, two options defined panels for optimal typing SNP before IVF were composed. Standard panel includes 8 SNP, 5 in thromborhilic factors, and 3 in folic acid cycle genes. They are 20210 G A of FII gene, R506Q G A of FV gene (mutation Leiden), -675 5G 4G of PAI-I gene, L33P T C of ITGB3 gene, -455 G A of FGB gene, 667 C T of MTHFR gene, 2756 A G of MTR gene, and 66 A G of MTRR gene. Extended panel of 15 SNP also includes 807 C T of ITGA2 gene, T154M C T of GP1BA gene, second polymorphism 1298 A C in MTHFR gene, polymorphisms of the renin-angiotensin gene AGT M235T T C and -1166 A C of AGTR1 gene, polymorphisms I105V A G and A114V C T of detoxification system gene GSTP.The results of SNP genotyping can be adjusted for treatment tactics and IVF, and also medical support getting pregnant. The success rate of IVF is increased as the result, especially in the group with the usual failure of IVF.

One of the effective methods of fertility preservation is an autologous transplantation of cryopreserved ovarian tissue. Currently, according to the world literature, after orthotopic autotransplantation of ovarian tissue 37 healthy children were born. In 2014 at the North-West Federal Medical Research Center it was established Cryobank of ovarian tissue, which is now kept 50 samples of ovarian tissue of man. Cryoconservation is performed by standard slow freezing. Autotransplantation of cryopreserved ovarian tissue has unique advantages over other methods of fertility preservation. This method does not lead to the postponement of anticancer therapy, safe for hormone-dependent cancer and can be performed regardless of the day of menstrual cycle and it is the only option for fertility preservation in prepubertal girls. The use of this method in clinical practice leads to restoration of endocrine function of the ovaries as well as of fertility in the future.