Infectious and inflammatory diseases are significant healthcare problems exacerbated by the increase in antibiotic resistance in pathogens. The ineffectiveness of traditional antibacterial therapy leads to prolonged infections, complications, and decreased patient quality of life. The article discusses the urgency of the problem of antibacterial drug use and reviews, from a clinical and legal point of view, the prospects for the use of enzyme-based agents as additional therapy. The mechanisms of action of enzymes, their potential effectiveness against resistant pathogens, the prevention of complications, and the possibility of combined use with antibiotics, considering legal and medical aspects, are discussed. The results of the studies demonstrate the prospects of using enzyme therapy to reduce the severity of the inflammatory process, improve the microbiocenosis state, increase the effectiveness of antibacterial therapy, and prevent complications of infectious and inflammatory diseases in gynecological practice. There is a legal justification for applying certain measures to prevent complications.

Background. Vaginal infection complicates the course of pregnancy and adversely affects perinatal outcomes for the mother and fetus. With the global increase in microorganism resistance to antimicrobial drugs, the treatment of vaginitis in pregnant women is not always effective, leading to recurrent pathology. Therefore, seeking new therapeutic solutions is a pressing task. Aim. To evaluate the effectiveness of a new form of benzyl-dimethyl [3-(myristoylamino) propyl] ammonium chloride monohydrate (Miramistin® suppositories) in the treatment of vaginitis in pregnant women. Materials and methods. A prospective study included 60 pregnant women with a confirmed diagnosis of nonspecific vaginitis. All patients received therapy with Miramistin® suppositories vaginally once a day for 7 days. Clinical dynamics and microbiological characteristics of the vaginal biotope were assessed. Results. Disappearance or significant reduction of clinical symptoms was noted in 96.7% of pregnant women within two days from the start of treatment. The duration of the relapse-free period was more than 4 weeks. No adverse drug reactions were observed. There was high satisfaction with the treatment results among both physicians and patients. Conclusion. Treating vaginitis in pregnant women using the new form of benzyl-dimethyl [3-(myristoylamino) propyl] ammonium chloride monohydrate (Miramistin® suppositories) is an effective method for controlling vaginal infection.

Menopause is associated with a deficiency of sex hormones, which significantly impacts a woman's physical and psycho-emotional state. In particular, the blood supply to the genitourinary system organs deteriorates, and the synthesis of connective tissue fibers of elastin and collagen is disrupted, resulting in atrophy of epithelial and muscle structures. Over time, microbiocenosis changes due to atrophic processes in the genitourinary system. These processes cause the development of genitourinary syndrome of menopause (GSM). The traditional pathogenetic method of treatment of GSM manifestations is local hormone therapy with estriol-containing drugs. However, there is a large cohort of women who have contraindications for hormonal agents or are unwilling to use them. A promising non-hormonal therapy option is a combination of agents containing phytoestrogens, hyaluronic acid, cytokines and antimicrobial peptides in the form of suppositories (Superlymph) and a dosed cream (Estrogial Plus), which have synergistic reparative, moisturizing, antioxidant, and antimicrobial effects. The article presents clinical cases of effective and safe use of a combination of non-hormonal agents in patients with GSM, which improved their quality of life and was confirmed by objective clinical and laboratory data.

One of the most controversial issues of modern gynecology is the study of the effect of combined oral contraceptives (COCs) on the endocrine-metabolic profile. Unfortunately, there are still hormonophobic prejudices in society about the adverse impact of COCs on body weight, carbohydrate metabolism, and lipid profile despite no evidence base for such judgments. Therefore, the purpose of the article is to analyze the effect of E4/drospirenone-based COCs on endocrine-metabolic parameters through the lens of evidence-based medicine.

Abdominal pregnancy (AP) is rare and is associated with high rates of maternal and perinatal mortality compared to other ectopic pregnancies (EP). Despite using advanced imaging techniques in prenatal diagnosis, diagnosing and treating AP remain challenging. Progressive advanced AP may remain undiagnosed for a long time due to the absence of specific clinical symptoms, errors in the interpretation of echographic patterns by radiologists, and a lack of alertness due to the rarity of this type of EP. This article describes two authors' observations of AP that resulted in critical obstetric conditions due to massive blood loss. The first case of AP in a pluripara patient concluded at week 34 with live birth and hysterectomy for placenta ingrowth (PAS2). In the second case, the AP was terminated early. In both patients, the trophoblast was implanted on the uterus; there were no known risk factors for EP, and the diagnosis of AP was established intraoperatively. According to modern Russian and foreign literature, in most cases, EP is diagnosed intraoperatively due to the lack of a standard algorithm for diagnosis and treatment. Standardization of treatment guidelines for AP trimesters II and III, perioperative treatment options, and postoperative management, based on a summary of all cases reported worldwide, could reduce the risk of maternal and fetal complications and mortality.

Vaginal contraceptive rings are one of the prolonged methods of preventing unwanted pregnancies that do not require daily use. The vaginal contraceptive rings have high contraceptive efficacy and several advantages over traditional oral pills, increasing adherence to the method due to the absence of the need for daily control by the woman. Also, it has some non-contraceptive properties and features that can be used in specific clinical situations that require tailoring a contraception method. The article presents a literature review on the vaginal contraceptive method, a comparative description of combined oral contraceptives with vaginal contraceptive rings, the main advantages and disadvantages of vaginal contraceptive rings, as well as the basic rules of professional counseling.

Background. In recent decades, the frequency of intrauterine pathology (IUP) has increased: endometrial hyperplasia and polyps, submucous uterine fibroids (SMUF), and other conditions that affect 38–72% of women of reproductive age. An imbalance in cell proliferation, differentiation, and death plays an important role in the pathogenesis of IUP. Aim. To study and assess proteins regulating cell apoptosis and proliferation in patients of reproductive age with various IUPs. Materials and methods. We analyzed the comprehensive examination data of 87 women of reproductive age (mean age 43.8±3.27 years) undergoing inpatient treatment at the N.V. Sklifosovsky Research Institute of Emergency Medicine from 2023 to 2024 with various IUPs. All patients underwent a general clinical and comprehensive instrumental examination (pelvic ultrasound, hysteroscopy, and/or hysteroresectoscopy with separate diagnostic curettage of the endocervix and endometrium and morphological examination of biopsy specimens). Plasma concentrations of proteins activating the external pathway of apoptotic cell death were measured: soluble Fas, soluble Fas ligand, and tumor necrosis factor-related apoptosis-inducing ligand. The growth factor levels were also measured: the main fibroblast growth factor, hepatocyte growth factor, and stem cell factor. A multiplex analysis was performed on the Luminex 200 platform (xMAP technology) using the MILLIPLEX MAP Human Circulating Cancer Biomarker Magnetic Bead Panel reagent kit. Based on the results of the morphological examination, patients were divided into four groups: Group 1 included 20 (22.9%) patients diagnosed with endometrial hyperplasia (EH) without atypia based on histological examination; Group 2 included 44 (50.6%) patients with endometrial polyps (EP); Group 3 included 16 (18.4%) patients with EP and concomitant EH without atypia; Group 4 included 7 (8.0%) patients with type 0–II SMUF according to the European Society of Hysteroscopy Classification of Submucous Fibroids with a node size of up to 3.5 cm. The comparison group for assessing the apoptosis of blood lymphocytes included 20 healthy females (HW) of reproductive age. Results. In patients with EH without atypia and EP, dysregulation of cellular homeostasis was observed due to a change in the balance of factors of cell apoptosis and proliferation. A decrease in the concentration of apoptosis trigger factors and an increase in soluble Fas, which functions as a "trap," is associated with abnormal induction of programmed death of endometrial cells. Also, the decrease in factors activating cell apoptosis may be due to decreased growth factors involved in physiological regeneration. In patients with SMUF, no changes in the regulation of apoptotic cell death were detected, while a decrease in stem cell growth factor was noted. Conclusion. The comprehensive use of instrumental methods improves the accuracy of diagnosis of various nosological forms of IUP. The analysis of the results supports further studies in patients with various types of IUP after surgical treatment and restoration of the menstrual cycle during the outpatient follow-up.

The problem of endometrial hyperplasia (EH) has been relevant for many years, primarily due to the association of abnormal endometrial proliferation with uterus malignancies. Endometrial cancer (EC) risk factors are known, with benign EH being one of the most important, while atypical EH is more likely to be a prognostic factor for the development of adenocarcinoma. The main clinical symptom of EH is abnormal uterine bleeding, but this symptom is not specific and occurs in many gynecological and non-gynecological conditions. In order to avoid unnecessary invasive interventions, clinical and laboratory criteria are being developed for selecting patients with a high risk of EH/endometrial neoplasia and for further diagnostic manipulations. The article discusses modern approaches to instrumental diagnosis and clinical assessment of risk factors in women of reproductive age and the postmenopausal period with and without symptoms of uterine bleeding. Treatment of EH, especially in the presence of cellular atypia, is challenging and not consistently effective, so prevention of EH and EC is the best strategic choice. For this purpose, combined oral contraceptives can be used due to their well-known carcinoprotective potential. The options for the choice of combined oral contraceptives most suitable for contraception in women at risk of EH and EC are given.

Aim. To evaluate the effectiveness of treatment of bacterial vaginosis (BV) with the nifuratel+nystatin complex and its effect on the lactobacillus profile (LBP) in the vagina. Materials and methods. A multicenter, prospective, observational study included 41 patients diagnosed with BV (main group) who were treated with vaginal capsules containing 500 mg of nifuratel and 200,000 IU of nystatin (Macmiror® Complex). Efficacy was assessed at 2 weeks and 4–6 weeks after treatment based on clinical data (absence of pathological discharge). The control group for the comparative assessment of LBP included 25 healthy women. Lactobacillus index (LI, the proportion of lactobacilli in the total bacterial mass) and the abundance of Lactobacillus crispatus, L. gasseri, L. jensenii, and L. iners were assessed using a polymerase chain reaction before treatment with BV, at 2 weeks and 4–6 weeks after the end of therapy, as well as in the control group. Additionally, the vaginal pH level was measured. Results. Clinical recovery was achieved in all main group patients and persisted throughout the observation. In all patients in this group, lactobacilli comprised 0.01–100% of the total bacterial mass. The frequency of lactobacilli species in the control group was relatively uniform, with a relatively uniform abundance of lactobacilli and a slight dominance of L. crispatus, with frequent isolation of two species in samples and high LI (70%) in 80% of females. Before treatment in the main group, the majority of vaginal samples contained one species of lactobacilli; 40% had LI70%, and in 62.5%, L. iners was isolated. LBP did not change significantly within 2 weeks after treatment, and after 4–6 weeks, it became comparable to that in the control group. A decrease in pH was associated with LBP recovery. However, there was no strong correlation between LI and individual species of lactobacilli in samples with or without BV. Conclusion. Nifuratel+nystatin complex is highly effective in BV treatment. The treatment had no adverse effect on LBP, which did not differ significantly immediately after treatment compared to the baseline. However, 4–6 weeks after the treatment, LBP recovered spontaneously, reaching comparable indicators with a group of clinically healthy females regarding species composition and LI.

Background. Preeclampsia (PE) is associated with a high risk of preterm birth, fetal growth retardation, perinatal and maternal mortality, neonatal hospitalization in the intensive care unit, and long-term negative consequences for both mother and child. FMF screening was a breakthrough in the diagnostic search for patients at risk of PE; this screening is currently used in many countries, including Russia. It uses the patient's history data and biophysical and biochemical indicators to improve PE prediction during pregnancy. Aim. To develop a risk rating score that practitioners can use as an adjunct to the first screening to improve the prognosis for PE. Materials and methods. In the first stage of the study, the medical records of 102 patients who gave birth and were diagnosed with severe PE in the branch of the State Clinical Hospital No. 24, the Perinatal Center, were reviewed. In this cohort of pregnant women, the significance of history and physiological risk factors was assessed, and a risk rating score was proposed. In the second stage of the study, the effectiveness of our risk rating score was assessed for 3,431 pregnant women who underwent the first prenatal screening in the antenatal fetal care department of the Moscow State Clinical Hospital named after V.V. Veresaev in 2021. When compiling the score, the absolute risk and the odds ratio were calculated to identify the most significant risk factors. Results. The integrated approach (screening and score) attributed to the high-risk group 80% of all pregnant women who subsequently had PE versus 54.6% using the screening alone and 38.7% using the risk rating score alone. Conclusion. The rating score, as part of the stage II screening, will increase the prognostic value for PE and help identify more patients requiring prevention.