Obstructive uropathy (OU) is a complication of urinary tract diseases, characterized by the presence of an obstacle in the urine outflow. This condition in pregnant women usually leads to urological and/or obstetric complications and requires timely diagnosis to optimize the treatment. A description of the ultrasound findings and a review of two cases of OU in pregnant women are presented. The indication for an ultrasound examination of the kidneys was clinical and laboratory findings. The identified signs and features of the OU became the basis for appropriate treatment and prevention of severe obstetric complications, which were avoided in our cases. However, the outcomes of the described clinical cases indicate the need for a more thorough urological and obstetric approach to women with obstruction uropathy. The ultrasound examination to detect obstructive uropathy in pregnant women, as well as the details and determination of possible etiological factors, were a reliable means of preventing severe obstetric and perinatal complications.

Background. Vulvovaginal infections are the most common, studied, and still causing many questions. It has been established that the disturbance of the ratio of the vaginal microbiota components does not always lead to a disorder since the development and outcome of the disorder largely depend on the state of the macroorganism, including the state of its immune system. To date, the only method for assessing the state of local immunity is smear microscopy with counting leukocytes. An alternative to leukocyte counting is the assessment of immunological parameters (e.g., the transcriptional profile of cytokine genes). An integrated approach to assessing the state of microbiocenosis (the ratio of lactobacilli and opportunistic pathogens) and local mucosal immunity, considering the individual genetic characteristics of patients and microorganisms, makes it possible to optimize treatment methods for vaginitis. One of the ways to increase the effectiveness of treatment and prevention of the recurrence of infectious and inflammatory diseases in gynecology is systemic enzyme therapy based on the complex effect of a specially selected combination of plant and animal origin enzymes on key physiological and pathophysiological processes in the body. Aim. To study the clinical effect and the effect of combined therapy with an antibiotic and a medicinal product, including a complex of enzymes of plant and animal origin (Wobenzym) on the state of the vaginal microbiota, the expression of cytokine genes, and the recurrence rate in patients with bacterial vulvovaginitis. Materials and methods. An open-label, single-center, prospective, comparative, randomized study enrolled 88 patients according to inclusion criteria. After randomization of patients into 2 groups, the main group received combination therapy (clindamycin vaginal cream 2% and Wobenzym), and patients of the comparison group received standard therapy only (clindamycin vaginal cream 2%). Short-term and long-term endpoints were defined. The primary endpoints included the assessment of symptoms, the change over time of the number of leukocytes in Gram-stained smears, and the recurrence rate; the secondary endpoints were the study of the change over time of the inflammation index, the results of the assessment of the state of the vaginal microbiota by real-time quantitative polymerase chain reaction using the Femoflor 16 reagent kit and a microbiological study. Results. When used in combination, Wobenzym potentiates the antibacterial properties of clindamycin, reduces the inflammation index, promotes the growth of the normal microbiota of the vagina (Lactobacillus spp.), prevents the growth of opportunistic microorganisms and, as a result, prevents the recurrence of vulvovaginitis. Conclusion. The results support the use of combination therapy (antibiotic + Wobenzym) to improve the effectiveness of therapy and maintain normocenosis.

Gestational trophoblastic disease is uncommon in practice. Usually a hydatidiform mole, an invasive mole and a choriocarcinoma are known among gynecologists. The practitioners have much less information about diseases associated with the intermediate trophoblast. These rare forms of trophoblastic disease are almost impossible to diagnose clinically. The morphological differential diagnosis is also quite difficult. Just careful attention to details, methodical study of the material, starting with routine staining methods, ending with immunohistochemical analysis, the use of molecular and cytogenetic typing, make it possible to establish the correct diagnosis and choose an effective therapeutic strategy. The article describes a rare clinical case of a placental site trophoblastic disease which was manifested by an ordinary abnormal uterine bleeding and then successfully diagnosed only by pathology experts.

Introduction. Cardiovascular diseases are still the leading cause of death worldwide. In contrast to men, in women, cardiovascular diseases, such as coronary artery disease, acute cerebrovascular accident, and thrombosis of various localization, develop later in life. A fold rise in risk begins during the menopausal transition. Given the increase in the postmenopausal period of a woman's life, it seems interesting to search for new methods of early prevention of cardiometabolic complications already in perimenopause. Aim. To optimize early non-hormonal prevention of endothelial dysfunction and perimenopausal cardiovascular complications. Materials and methods. A prospective study included 50 patients aged 45–55 years in perimenopause without obesity and other somatic or gynecological disorders with menopausal syndrome of varying severity. Patients in group 1 (n=25) received combined non-hormonal treatment of menopausal symptoms and prevention of cardiovascular complications [sulodexide 250 lipasemic units (LU) 2 times a day + phytoestrogen (cimicifuga extract) 1 capsule 2 times a day]. In group 2 (n=25), patients received only phytoestrogen according to the same regimen. Results. After 1 year of observation, the mean thickness of the intima-media complex of the common carotid artery in group 1, in which patients received complex course therapy including sulodexide (Vessel Due F), decreased by 3.7%, and in group 2 increased by 26.8%. In group 1, it was found that after 1 year of regular use, treatment contributed to a decrease in blood fibrinogen level by 11.8% and an increase in thrombin time by 24.5%, which, in combination with a decrease in prothrombin concentration and an increase in activated partial thromboplastin time by 4.7 s, indicates a pronounced therapeutic effect on the hemostasis system. Conclusion. All markers of early atherosclerosis and vascular complications progress during postmenopause and with increasing age. However, complex protective therapy, including glycosaminoglycans sulodexide), can slow down this progression while improving patients' quality of life. Non-hormonal complex therapy can not only neutralize menopausal symptoms but also prevent long-term vascular complications caused by increasing age and the lack of estrogen-protective effect.

Disruption of the structure and function of the vulvovaginal epithelium in women of reproductive age is accompanied by impaired sexual function and a decrease in the quality of life. This review analyses research on the use of hyaluronic acid (HA) for women of reproductive age with conditions and diseases manifesting as vulvovaginal atrophy. HA is involved in various physiological processes, including tissue regeneration, cell migration and proliferation during inflammation, and helps maintain water balance and tissue integrity. Local therapy with HA is effective in treating the symptoms of vulvovaginal atrophy in women of reproductive age associated with hypoestrogenism, both as a monotherapy and in combination with other treatments. It improves sexual function and quality of life, helping women to improve their sexual lives and living standards.

Modern strategies of the World Health Organization and clinical guidelines of the world's leading professional communities of obstetricians and gynecologists, based on effective clinical practices, make it possible to attribute sepsis to potentially preventable causes of direct maternal mortality with the possibility of a near-miss situation outcome. Necrotizing fasciitis (NF) is a disseminated soft tissue infection that is a rare and life-threatening form of septic complications in obstetrics. The disease is little known to practical doctors, and its outcome largely depends on the timely diagnosis and early initiation of adequate treatment, including massive antibiotic therapy and urgent surgical removal of necrotic tissue with correction of multiple organ disorders. Pregnant women and women in labor are at risk for NF since its main risk factors are mucosal and skin injuries of any origin, immunosuppression, diabetes, and obesity. We present two cases of near miss due to the NF and sepsis after vaginal birth and cesarean section. At the manifestation of the disease, both patients started broad-spectrum antibiotic therapy. When soft tissue necrosis appeared, debridement was performed. A 31-year-old patient had a more severe course of the disease (septic shock, severe multiple organ failure) and a less favorable outcome (hysterectomy, panhypopituitarism, large ventral hernia), which is probably due to the presence of significant risk factors (history of sepsis, grade 1 obesity, autoimmune thyroiditis). In a 37-year-old somatically healthy patient with only one risk factor (age over 35 years), NF's clinical course and outcome after cesarean section were more favorable (the uterus was preserved, and the hormonal and metabolic status was not disturbed). Pregnant women and women in labor should be identified as a risk group for NF due to unavoidable damage of the mucous membranes and skin even during normal childbirth and routine obstetric procedures, a high rate of surgical delivery, physiological immunosuppression, and a high prevalence of obesity and diabetes. Rapidly initiated complex treatment, including massive antibiotic therapy, debridement, immunoglobulins, efferent therapies, and hyperbaric oxygenation, can improve the outcome of the disease and prevent maternal mortality.

Background. Breast cysts are a relatively common benign condition, accounting for 26.4% of all benign mammary dysplasias (BMD). Due to scientific and technological progress, in many cases, it is possible to achieve improvement from non-surgical and complex therapy, including minimally invasive technologies such as image-guided air injections with non-surgical treatment. Aim. To determine the optimal approach for the management of benign breast cysts and to provide a rationale for the combined use of air injections with phytotherapy. Materials and methods. The study included women aged 25 to 45 years (mean age was 37.7±5.6 years) taking combined oral contraceptives (COCs) for at least 3 years with benign breast cysts. Patients were randomized into two groups: Group 1 (n=26) included patients with a cystic form of BMD who received a fine-needle puncture followed by air mixture injections into the cyst cavity in combination with non-surgical therapy with the herbal medicinal product Mastopol®; Group 2 (n=19) included patients with a cystic form of BMD who received only air injections into the cyst cavity. The dosing regimen of Mastopol® in patients of Group 1: 1 tablet sublingually 3 times a day 20 minutes before meals. The non-surgical therapy was initiated on the day of the air injection. The duration of treatment with Mastopol® was 3 months. Results. A pain decrease was reported in 18 patients (69.2%) of Group 1; in Group 2, only 2 (10.5%) patients reported a pain decrease. Almost all patients of Group 2 (n=17; 89.5%) required repeated air injections for complete cyst reduction, while in Group 1, only 31% (n=8) of patients received repeated air injections. Comparative analysis showed a significant difference between the groups: φ*=1.7; p≤0.04. One month after treatment and air injections, mastalgia of varying intensity in Group 1 persisted in 31% (n=8) of patients and 89.5% (n=17) of patients in Group 2. Conclusion. While taking COCs, women may experience pain and tension in the breast, as well as an increase in the echo density of the breast and thickening of the glandular tissue and the wall of the cysts. These adverse effects of COCs must be reduced. The results of the study demonstrated the effectiveness of the antiproliferative herbal drug Mastopol®, prescribed in combination with an adequate, effective, and safe method such as air injection into the cyst cavity.

Aim. To study the associations of single nucleotide polymorphisms (SNP) of candidate genes associated according to genome-wide association studies (GWAS) with the content of sex hormone binding protein (SHBG) with the occurrence of moderately (G2) and low (G3) differentiated breast cancer. Materials and methods. The study samples included 271 patients with breast cancer, of which 157 had a G2 tumor differentiation and 114 – G3, and 1140 women of the control group. In the study groups, genetic testing of 4 GWAS-significant for SHBG SNPs was performed: g.80549739AG ZBTB10 (rs440837), g.63379150TG JMJD1C (rs7910927), g.7618597GT SHBG (rs12150660), g.21178615TC SLCO1B1 (rs4149056). Results. Polymorphic gene variants associated with SHBG are associated with G2 differentiation in BC but not with the risk of high-grade tumor (low-grade differentiation). The single nucleotide substitution of rs440837 AG in the ZBTB10 gene is associated with G2 differentiated BC according to additive (GG vs AG vs AA; odds ratio 0.70; 95% confidence interval 0.50–0.99; p=0.041; pperm=0.042) and dominant (GG+AG vs AA; odds ratio 0.58; 95% confidence interval 0.39–0.87; p=0.008; pperm=0.009) genetic models and the minor allelic variant of G rs440837 was a protective factor in the occurrence of a moderately differentiated tumor. The polymorphic variant of rs440837 AG in the ZBTB10 gene is the most important epigenetic modifier in the liver (associated with enhancers and promoters); it affects the alternative polyadenylation of the ZBTB10 gene mRNA in the thyroid gland. Conclusion. According to GWAS, the G rs440837 (AG) allele in the ZBTB10 gene, which is associated with high SHBG, reduces the risk of moderately differentiated BC.

Over the past few decades, the attention of gynecologists and reproductive specialists has been drawn to the key causes of female infertility, among which chronic endometritis (CE) dominates. The aim of the paper is to inform gynecologists about the need for a comprehensive approach (considering comorbidities) to diagnose and treat CE using medical and physiotherapeutic treatment methods. The article presents a prospective review of pregravid preparation, considering the features of the examination, verification of the diagnosis, and treatment of two patients with a history of reproductive losses due to CE. The presented clinical cases demonstrate the importance of multidirectional diagnosis of CE, the mandatory morphological examination to verify the diagnosis, as well as the feasibility of prescribing complex therapy using both drug (antimicrobial therapy, immunomodulatory, hormonal, and combined broad-spectrum agents) and physiotherapeutic methods of treatment.

Anemia is a global health problem, affecting about a quarter of the world's population, especially women of reproductive age and young children. In 50–75% of cases, anemia is secondary to iron deficiency (ID). Despite the high prevalence of heavy menstrual bleeding (HMB), the associated iron deficiency disorders are underestimated, although they sharply reduce the quality of life and carry significant risks for the mother, fetus and newborn in case of pregnancy. For this purpose, routine screening of girls and women of reproductive age for the presence of ID and anemia is recommended. The new FIGO initiative aims to raise awareness among women and clinicians about the relationship between HMB and ID conditions. Of key importance are: early diagnosis of HMB, elimination of the possible cause, identification of associated iron deficiency disorders, especially preclinical forms. The main task of the gynecologist is to prescribe therapy aimed at quickly stopping high monthly iron losses and replenishing the existing ID. According to Russian clinical guidelines, combined oral contraceptives and an intrauterine system with levonorgestrel are considered first-line therapy to reduce the volume of menstrual blood loss in patients with HMB who require contraception. Qlaira® and Mirena® are the only hormonal drugs registered for contraception and the treatment of HMB not associated with structural disorders of the uterus, since their high effectiveness in reducing menstrual blood loss, restoring hemoglobin and ferritin levels has been confirmed in studies with a high level of evidence.