Obstetrics and Gynecology

Urinary incontinence in women is a significant public health issue, as it affects 25–45% of the adult female population. This condition has a negative impact on various aspects of a woman’s life, including social, professional, and sexual well-being. Different types of urinary incontinence are based on various pathogenetic mechanisms, but the correlation between urinary incontinence and obstetric factors is well known. Anatomical and metabolic changes that occur in a pregnant woman increase the risk of urinary incontinence, both during pregnancy and in the postpartum period. Urinary disorders during pregnancy and after childbirth are predictors of urinary incontinence in subsequent periods of a woman’s life.

This review presents new scientific data on the prevalence of urinary incontinence among pregnant women and its impact on the quality of life during pregnancy. The article discusses the pathogenetic mechanisms leading to urinary incontinence during pregnancy (increased pressure of the growing uterus and fetus on the pelvic floor muscles, increased mobility of the neck of the bladder and urethra, urethral sphincter insufficiency, increased progesterone levels, decreased levels of relaxin and collagen).

The article presents the results of studies aimed at identifying risk factors for urinary incontinence during pregnancy and after childbirth.

Clinical studies have been analyzed and their results show that pelvic floor muscle training is essential for the prevention and treatment of urinary incontinence in pregnant women.

Conclusion: It is necessary to conduct further research into the mechanisms of development and risk factors for urinary incontinence in pregnant women, as this will contribute to improving and developing both existing and new preventive and treatment strategies for this medical condition.

Diminished ovarian reserve (DOR) is characterized by a decrease in the number and quality of oocytes. The pathogenesis of DOR remains unclear, which makes this condition one of the most challenging problems in the field of infertility treatment and assisted reproductive technologies. The development of the oocyte is directly dependent on its “molecular dialog” with granulosa cells; therefore, studies of the epigenetic mechanisms underlying DOR are primarily focused on detailing, clarifying, and identifying epigenetic changes induced by hormones and other extracellular molecules not only in oocytes but also in ovarian granulosa cells.

This review provides a detailed analysis of various factors that play a role in the pathogenesis of DOR, including epigenetic modifications such as DNA methylation, N6-methyladenosine (m6A) modifications and changes in the expression levels of long non-coding RNAs and microRNAs in granulosa cells and oocytes in DOR. These epigenetic changes affect the biological functions of cells by controlling the expression of protein-coding genes and thus all intracellular signaling pathways responsible for oocyte development. This review examines the role of epigenetic alterations in DOR, providing new insights into its pathogenesis and clinical diagnosis. In addition, the article discusses the possibility of potential application of targeting epigenetic modifications for the therapeutic correction of DOR.

Conclusion: The data presented in the review make it possible to clarify the characteristics of DOR pathogenesis and the impact of epigenetic modifications on the processes of folliculogenesis and oogenesis. The study of epigenetic regulation has been gaining the attention of more and more scientists around the world. This suggests that future research will identify new epigenetic factors related to DOR. Epigenetic modifications may become new diagnostic markers for assessing ovarian function, and their analogues or inhibitors may be used as targeted therapies in the future.

Objective: To summarize the current data on the role of genetic factors in female infertility, including disorders of oocyte maturation, fertilization, embryonic developmental arrest, and to consider the possibilities of molecular genetic diagnosis.

Materials and methods: The article presents a review of recent Russian and foreign publications on the molecular and chromosomal etiology of female infertility with focus on phenotypes associated with pathogenic gene variants, as well as modern methods of molecular analysis (WES, WGS, GWAS).

Results: Female infertility affects 10-15% of reproductive-aged couples, while up to 30% of cases remain idiopathic. Genetic factors play a leading role in the pathogenesis of infertility, especially with repeated ART failures. Chromosomal and monogenic mechanisms have been identified in both syndromic and non-syndromic forms. More than 90 genes associated with premature ovarian insufficiency have been found; TUBB8, PATL2, TRIP13, TBPL2, ZP1-3, WEE2, CDC20, BTG4, PADI6, and other genes determine the phenotypes of disorders of oogenesis, fertilization and early embryogenesis. Key molecular complexes have been identified, including the subcortical maternal complex (SCMC), which is critically important for early embryo development. The use of NGS technologies made it possible to better understand the genetic basis of infertility and to identify new clinical variants.

Conclusion: The genetic etiology of female infertility is more complex than previously believed; therefore, it is necessary to integrate molecular genetic methods into the practice of obstetricians, gynecologists and reproductive medicine specialists. Precision diagnosis and genetic counseling can increase the effectiveness of ART programs and help personalize the choice of treatment options.

Functional hypothalamic amenorrhea is a disease of reproductive-aged women, which is due to impaired activity of the hypothalamic-pituitary-ovarian axis. The main etiological factors leading to the manifestation of functional hypothalamic amenorrhea have been widely described but their elimination does not always result in the restoration of the menstrual cycle rhythmicity. Therefore, it is necessary to search for additional mechanisms that determine the duration of the disease and explain the lack of effectiveness of standard therapeutic strategies.

Increasing amounts of data suggest a significant role of genetic factors in the development and course of functional hypothalamic amenorrhea. It is believed that polymorphisms of genes involved in the regulation of energy metabolism, stress response, and hormonal homeostasis can influence the sensitivity of hypothalamic neurons to external stressors and modify individual responses to them.

During the preparation of this review, the studies on this subject available in the PubMed and eLibrary databases were analyzed. A search was conducted for articles published between 2014 and 2025 using the following keywords: functional hypothalamic amenorrhea, hypogonadotropic hypogonadism, stress, disordered eating, excessive exercise.

Conclusion: A detailed study of the genetic mechanisms underlying functional hypothalamic amenorrhea could help better understand its pathogenesis, confirm the multifactorial nature of the condition and open up opportunities for the development of personalized treatment strategies. This could also aid in predicting the course of the condition and facilitate early identification of high-risk individuals.

Antiphosphatidylserine/prothrombin complex (aPS/PT) antibodies are an additional set of biomarkers that can be used to detect thromboembolic and obstetric complications, in addition to the traditional panel of phospholipid antibodies.

Objective: To determine aPS/PT levels in patients with healthy pregnancies.

Materials and methods: A study of serum aPS/PT IgG and IgM levels was conducted in 50 pregnant women with normal pregnancies during the first, second, and third trimesters of gestation.

Results: The median level of aPS/PT IgG in pregnant women during the first trimester was 3.77 (2.67; 5.72) U/ml; in the second trimester, it was 3.48 (2.93; 5.39) U/ml; and in the third trimester, it was 3.72 (3.02; 4.79) U/ml. The median level of aPS/PT IgM in these patients was 3.6 (2.61; 5.09) U/ml in the first trimester; 4.1 (2.65; 5.4) U/ml in the second trimester; and 5.0 (3.41; 6.38) U/ml in the third trimester. Statistically significant changes were observed only in the third trimester (p=0.018).

Conclusion: The scientific community recognizes aPS/PT among non-criterial phospholipid antibodies as a promising diagnostic marker that may enhance the effectiveness of antiphospholipid syndrome diagnosis. Further studies involving patients with complicated pregnancies are needed to determine the significance of aPS/PT and confirm their potential use in the clinical practice of obstetricians and gynecologists.

Objective: To evaluate the effectiveness of metroplasty via vaginal access in patients with uterine scar after cesarean section (CS).

Materials and methods: This comparative prospective study included 100 patients with a confirmed diagnosis of cesarean scar defect who were planning to become pregnant. The first group of patients (n=50) underwent metroplasty using vaginal access, 10 patients underwent laparotomy (group 2), and the third group (n=40) underwent metroplasty using traditional laparoscopic access. All patients in the study groups were evaluated based on the following criteria: complaints; condition of the uterine scar six months after surgery, as determined by ultrasound data; duration of surgery; amount of blood loss; characteristics of the pain syndrome experienced in the first six hours after surgery; and presence of complications. A comparative analysis of the results of the three surgical treatment methods was conducted.

Results: The following characteristics were identified in the study groups: after CS, the main complaints included menstrual cycle disorders, such as prolonged spotting after menstruation, heavy and frequent menstruation with a regular cycle (menorrhagia, polymenorrhea), painful menstruation, and secondary infertility. Following metroplasty in the study groups, clinical manifestations regressed in all patients after six months. The mean minimum thickness of the myometrium in the scar area increased significantly: in group 1, it ranged from 3.8 to 5.35 mm with a mean value of 5.3 (0.8) mm; in group 2, it ranged from 4.5 to 5.2 mm with a mean value of 4.9 (0.3) mm; and in group 3, it ranged from 3.8 to 5.3 mm with a mean value of 4.7 (0.5) mm. The “scar thickness, mm” indicator dynamics were significantly different before and after metroplasty in all the study groups (p<0.0001). The use of the vaginal method of uterine scar correction showed comparable results, with the following features noted: the duration of the operation in group 1 ranged from 20 to 55 min, with a median time of 35 (30; 40) min; in group 2, the duration of the operation ranged from 75 to 120 min, with a median time of 95 (90; 120) min; and in group 3, the duration of the operation ranged from 70 to 135 min, with a median time of 95 (90; 110) min. This is associated with a more technically simplified surgical correction technique that does not require a laparoscopic stand. Group 1 differed significantly from groups 2 and 3 (p_1,2=0.0003 and p_1,3<0.0001, respectively). The following features were identified when assessing the severity of pain syndrome using VAS: in group 1, the VAS score ranged from 1 to 5 points, with a median of 2 (2; 3); in group 2, it ranged from 6 to 7 points, with a median of 6 (6; 7); and in group 3, it ranged from 4 to 6 points, with a median of 5 (4; 5). Group 1 significantly differed from groups 2 and 3 (p_1,2= 0.00002 and p_1,3= 0.00030, respectively), whereas groups 2 and 3 did not differ significantly in terms of VAS scores (p_2,3= 0.79). Histological examination of the uterine scar in the study material revealed moderate to severe expression of markers of chronic endometritis (CD 138, CD 56, and CD 20), indicating a chronic inflammatory process, concurrent infertility, miscarriage, and failed in vitro fertilization attempts. In several cases, endometrioid lesions were observed in the study material.

Conclusion: The study demonstrated that vaginal access metroplasty is highly effective and has certain advantages over traditional laparoscopic techniques. Therefore, it can be considered the preferred surgical treatment option in areas with limited resources and appropriately qualified specialists.

Objective: To evaluate the effectiveness and safety of non-ablative neodymium laser for the treatment of vulvovaginal atrophy (VVA) symptoms in postmenopausal women.

Materials and methods: The study included 120 patients aged 50 to 85 years with symptoms of postmenopausal VVA. According to the standard regimen, all patients underwent treatment with topical estriol (n=40), or three sessions of non-ablative neodymium laser therapy with an interval of 4–6 weeks between sessions (n=40), or a combination of laser treatment and topical estriol (n=40) between 2021 and 2023. The effectiveness of the therapy was assessed using the vaginal health index (VHI) and validated questionnaires: the Female Sexual Function Index (FSFI), the Vulvovaginal Symptom Questionnaire (VSQ), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the visual analogue scale (VAS). The observation period accounted for 9 months from the onset of treatment.

Results: Statistically significant differences were observed between pre-treatment and follow-up visits, and between groups at follow-up visits. It was shown that in the laser and combination therapy groups, compared with the hormonal treatment group, after 3 and 9 months from the start of therapy, the average score on the PISQ-12 questionnaire significantly increased, and the severity of VVA symptoms on the VAS scale decreased (up to complete elimination). According to the VHI data, a statistically significant difference was noted after 3 and 9 months from the start of therapy in the laser and combination treatment groups compared to the hormonal treatment group. Analysis of the changes in the VSQ questionnaire scores revealed a significantly more pronounced symptoms reduction in the laser and combination therapy groups in comparison with the hormonal treatment. However, no statistically significant differences were found in the effectiveness of laser monotherapy and combination therapy. When assessing the FSFI questionnaire scores 3 and 9 months after the start of therapy, a statistically significant increase in scores was observed in all groups. A statistically significant difference was noted after 3 and 9 months from the start of therapy in the laser and combination treatment groups compared to the hormonal treatment group, while the highest changes in subjectively assessed indicators of the quality of sexual life were detected in the laser treatment group without the use of hormonal therapy.

Conclusion: Localized neodymium laser therapy is an effective treatment for VVA symptoms and has a positive effect on the quality of women's sexual life.

Objective: To evaluate the frequency of cervical lesions with atypical squamous cells of uncertain significance (ASCUS) in patients with chronic endometritis (CE) and the effectiveness of treatment using a complex of natural antimicrobial peptides and cytokines.

Materials and methods: A prospective open-label randomized controlled trial included 1,126 patients with CE. Group I (n=563) received a natural antimicrobial peptide and cytokine complex (Superlymph) at a dose of 25 U/day per vaginam for 20 days. Group II (n=563) did not receive the peptide-cytokine complex. Both groups underwent antimicrobial therapy. Examination methods included real-time polymerase chain reaction and Pap test.

Results: The patients' age ranged from 18 to 45 years: 36.0 (3.1) years in Group I and 35.9 (4.4) years in Group II (p=0.22). ASCUS was detected in 45.5% (256/563) and 42.6% (240/563) of patients (p=0.37), and human papillomavirus (HPV) was identified in 71.6% (403/563) and 71.8% (404/563), respectively (p=1.0). In patients who suffered from ASCUS before treatment, the condition improved in 85.6% (219/256) and 45.8% (110/240) in groups I and II, respectively. The potential for recovery was 2 times higher when using Superlymph (ОР=1,87, 95% ДИ 1,61; 2,16). HPV-negative status after treatment was observed in 85.4% (481/563) of patients in Group I versus 29.7% (167/563) in Group II (OR=0.21, 95% CI 0.17; 0.26, p<0.001).

Conclusion: Among patients with CE, the prevalence of ASCUS is 44.1%, and the prevalence of HPV-positive status is observed in 71.7% of women. Combination therapy with Superlymph promotes the resolution of ASCUS in 85.6% of patients (a 2-fold risk reduction compared to antibacterial/antimycotic therapy alone) with a negative HPV test rate in 85.4% of CE patients after treatment.

Objective: To identify the potential of using the method of tight bandaging of the uterus in the complex treatment for hypotonic bleeding.

Materials and methods: This was a comparative study that included 12 patients with hypotonic bleeding who were divided into 2 groups of 6 people each. The patients of the main group had tight uterine bandaging that was used as a part of complex therapy along with traditional methods of hemostasis. The patients of the comparison group underwent treatment with standard methods without bandaging. The volume of blood loss, the need for invasive interventions, and outcomes were compared.

Results: The total blood loss was 1200–2500 ml in the main group, and it was 2600–3500 ml in the comparison group. Tight bandaging provided a temporary or permanent cessation of bleeding, and in some cases it prevented embolization of the uterine arteries and repeated surgical interventions. All patients of the main group had their uterus preserved; there were no complications related to the bandaging technique. The method proved to be effective and available in the absence of advanced technologies.

Conclusion: Tight bandaging of the uterus as a part of complex treatment for hypotonic bleeding helps to reduce blood loss, decrease the number of invasive procedures and preserve reproductive potential; therefore, this method can be recommended in providing obstetric care in hospitals at various levels.

Relevance: Currently, women are living longer, which means a need for long-term use of menopausal hormone therapy (MHT). Improving quality of life is one of the main criteria for prescribing MHT. However, the benefits of MHT do not always outweigh the risks in certain medical conditions. Therefore, the use of MHT should be strictly justified and individualized.

Objective: To study clinical, laboratory and instrumental parameters in women in early postmenopause under tibolone intake.

Materials and methods: 41 postmenopausal women were enrolled in an observational study conducted at Pirogov City Hospital No. 1 during the period of September 2024-September 2025. Participants took the hormone replacement therapy (MHT) tibolone (Leatrisa) for 6 months. The study included an analysis of complaints and monitoring of changes in the key instrumental and laboratory indicators after 2 and 6 months of tibolone intake.

Results: The results of the study revealed no growth of the endometrium during the tibolone intake (3.16 mm at the beginning of the study, 2.95 mm after 6 months of taking tibolone). Abnormal uterine bleeding was observed for a short period in 7.3% of patients, which did not require surgical intervention. When analyzing the major indicators (lipid profile, atherogenic index, coagulation profile, D-dimer), no statistically significant changes were detected during the observation period, which indicates the absence of a negative effect of the studied hormonal drug on the lipid profile and hemostasis. In addition, no deterioration in extragenital pathology was demonstrated; for example, in patients with hypertension, there was no increase in blood pressure, which did not require correction of antihypertensive therapy.

Conclusion: Our study showed that tibolone has no proliferative activity on the endometrium or mammary glands, does not affect the growth of myomatous nodes in the short term, and has no negative impact on lipid profiles or hemostasis. Women using tibolone reported a significant reduction in the severity of menopausal symptoms.

Background: Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder, best known as a complication of chronic alcoholism, but it can also occur in pregnant women with excessive vomiting due to thiamine deficiency. This condition requires urgent intervention to prevent irreversible neurological damage and fatal outcomes. WE is characterized by the classic triad of symptoms: oculomotor disturbances, cerebellar dysfunction, and altered mental status. Despite the good understanding of WE due to alcoholism, this condition is often undiagnosed in pregnant women since it has nonspecific clinical presentation and it may be similar to other pregnancy complications.

The article provides a review of the pathogenesis, diagnosis, and treatment of WE in pregnant women, as well as a clinical observation of a patient with WE in the first trimester.

Case report: A pregnant woman in her first trimester presented with complaints of persistent vomiting, confusion, and ataxia. Severe hyperemesis gravidarum, metabolic disorders, and neurological pathology were considered during the differential diagnosis. Laboratory tests revealed thiamine deficiency, and MRI scans confirmed the diagnosis of Wernicke’s encephalopathy. The patient was immediately treated with high doses of intravenous thiamine, which led to her recovery. This observation demonstrates the difficulties in diagnosing WE during pregnancy, especially in differentiating it from other causes of neurological symptoms. Timely recognition and thiamine replacement therapy played a significant role in preventing irreversible consequences.

Conclusion: Although rare, Wernicke’s encephalopathy is a life-threatening complication of hyperemesis gravidarum that requires immediate thiamine administration. Clinicians should remain highly alert to this condition in pregnant women who experience prolonged vomiting and neurological symptoms, as delayed diagnosis can lead to irreversible cognitive and motor impairments. The presented case emphasizes the significance of early administration of thiamine for patients at risk, and the need to increase awareness of this condition among obstetricians, gynecologists, and neurologists. It is necessary to carry out further research to develop standardized protocols for the diagnosis and treatment of WE during pregnancy.

Background: Ruptured splenic artery aneurysm in pregnant women is one of the causes of near miss events, maternal death and antenatal fetal death. The diagnosis of ruptured splenic artery aneurysm in pregnancy can be challenging, therefore it is important to analyze each case to prevent adverse outcomes.

Case report: The article presents a description and analysis of a clinical case of ruptured splenic artery aneurysm with massive blood loss in a pregnant woman at 36–37 weeks’ gestation. It is the case of dichorionic diamniotic twin pregnancy complicated by moderate COVID-19. The medical team consisting of experts in obstetrics and gynecology, surgery, anesthesiology, intensive care, and transfusion medicine, promptly provided emergency medical assistance, resulting in a successful outcome.

Conclusion: It is necessary to remember about the spontaneous rupture of a splenic artery aneurysm as one of the likely causes of intra-abdominal bleeding in women during pregnancy, childbirth and the postpartum period.

Background: Benign metastasizing leiomyoma is a rare condition characterized by the development of multiple slow-growing tumors composed of smooth muscle cells that form in atypical locations, primarily in lung tissue. These tumors are usually discovered after a considerable period of time following a myomectomy. This pathology is characterized by a mostly asymptomatic course, which makes it difficult to detect and often leads to accidental detection during examinations for other reasons. Despite the benign histological picture, the tumor can have a clinically aggressive course and can result in serious complications as well as increase in mortality.

Case report: The article presents a clinical case of bilateral lung lesion caused by benign metastasizing leiomyoma in a 50-year-old woman after myomectomy performed 11 years before. The disease was characterized by the latent course; the pulmonary metastases were accidentally detected during a routine examination. The therapeutic strategy included consistent surgical resections of the lesions in combination with surgical hormonal deprivation.

Conclusion: Due to the lack of approved clinical protocols for managing patients with benign metastasizing leiomyoma, it is very important to have a systematic description of such cases, since it may give an insight into the pathophysiological mechanisms and characteristics of this disease. Each clinical observation has a significant scientific value and makes it possible to obtain the information for developing the optimal treatment approaches and evaluating prognostic criteria.