Research Institute of Obstetrics and Gynecology named after D.O. Ott

The aim of this study is to evaluate the safety of robot-assisted sacrocolpopexy (RSP) compared with other approaches of sacrocolpopexy and vaginal surgery in pelvic organ prolapse (POP). The search was performed on studies published prior to May 2024. The inclusion criteria were randomized and nonrandomized trials involving adult women with POP. Exclusion criteria comprised other forms of intervention treatments and articles lacking comparative analyses. This study adhered to the Population, Intervention, Comparison, and Outcome framework, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist, and was registered in the Prospective Register of Systematic Reviews. The systematic review included 36 studies, whereas the meta-analysis included 30 studies. RSP demonstrated superior outcomes compared with laparoscopic (LSP), abdominal (ASP), and vaginal surgery (VS) approaches, with fewer perioperative complications (p < 0.00001 for RSP vs ASP; p = 0.01 for RSP vs VS), reduced blood loss (total p < 0.00001 for RSP vs LSP, ASP, and VS), and shorter hospital stays (p = 0.003 for RSP vs LSP; p = 0.27 for RSP vs VS). Additionally, RSP had fewer surgical conversions than LSP (p = 0.01). However, LSP and VS showed significantly shorter operation times than RSP (p < 0.00001). Robot-assisted sacrocolpopexy may offer advantages in reducing blood loss compared with VS and shortening hospital stays compared with LSP. Sensitivity analyses, however, revealed no significant differences in perioperative complications or blood loss compared with LSP and ASP. Further high-quality randomized studies are necessary to confirm the safety and efficacy of RSP.

Assisted reproductive technologies (ART) are becoming more and more popular methods of infertility treatment all over the world every day. Since the birth of the first child after IVF in 1978, the number of women resorting to ART as a method of overcoming infertility has been steadily increasing. Among all ART, in vitro fertilization (IVF) is the most effective and common way to overcome infertility. Gestational diabetes mellitus (GDM) is one of the leading complications of pregnancy, according to various authors, its incidence reaches from 1% to 14%. The prevalence of GDM in the group of pregnant women after IVF is significantly higher than the average in the general population of pregnant women and, according to various data, amounts to 12.6%. ART is an independent risk factor for the development of GDM.

BACKGROUND: According to modern concepts, the kisspeptin signaling system is the upper (central) link in the regulation of reproductive function. The neuropeptide kisspeptin is considered an indicator of a number of obstetric pathologies in humans. Therefore, it should be considered important to search for new synthetic analogues of natural kisspeptins as pharmacological agents of reproduction regulation. On the other hand, it should also be considered important to search for new effective model organisms in which certain effects manifest themselves most prominently compared to traditional experimental animals. AIM: To quantify the effect of kisspeptin-14 on the level of gonadoliberin and progesterone in two doses, at the time typical for the action of neuropeptides, on the model organism Danio rerio. METHODS: In this study, an analogue of kisspeptin, conventionally designated kisspeptin-14, was used. All Danio rerio females had reached puberty by the time of the experiment (6–8 months). Kisspeptin was administered in doses of 1 and 4 ng. The groups were analyzed 1 and 4 hours after administration. Before administration of the preparations, the fish were subjected to lidocaine anesthesia at a concentration of 40 mg/l for 5–6 minutes, then the drug was administered intracerebroventrically. After waiting for 1 or 4 hours, the material was collected (gonads and midbrain). Gonad and midbrain samples were homogenized, homogenates were suspended, and enzyme immunoassay was performed to determine hormone concentrations. RESULTS: Administration of kisspeptin-14 at a dose of 1 ng led to an increase in gonadoliberin levels 4 hours after administration. With a shorter time after administration, no statistically significant results were found. Administration of kisspeptin-14 at doses of 1 and 4 ng led to an increase in progesterone levels in the gonads of Danio rerio females 1 and 4 hours after administration. At the same time, statistically significant differences compared with the control group were noted at different sample collection dates. CONCLUSION: Intracerebroventricular administration of the kisspeptin-14 at a dose of 1 ng after 4 hours causes an increase in gonadoliberin in the structures of the midbrain. Intracerebroventricular administration of kisspeptin-14 causes an increase in progesterone in the gonads of Danio rerio females. There was no unambiguous relationship between changes in the concentration of gonadoliberin in the structures of the midbrain and changes in the concentration of progesterone in the gonads of females.

Objectives To evaluate fetal thigh (TVol) and arm (AVol) fractional volume in pregnant women with pregestational diabetes (PGD) and normal glucose tolerance and to assess its ability to predict fetal macrosomia, defined as a birth weight of 4000 g or greater. Methods A single‐center prospective cohort longitudinal study was conducted from February 2022 to November 2023. Women with a singleton pregnancy were enrolled in the study. Patients with severe extragenital pathology other than PGD, with fetal growth restriction, hemolytic disease, fetal malformations and anomalies, and gestational diabetes were excluded. The groups were those with PGD (n = 60) and the control group (n = 35). All patients underwent ultrasound examination three times during the third trimester, including standard biometry and assessment of fractional limb volume using 5D Limb Vol™ software (Samsung Medison). The primary outcome was a fetal macrosomia. Results Fractional limb volumes in the PGD group (TVol 64.8, AVol 30.2 mL) exceeded those in the control group (TVol 51.7, AVol 22.5 mL, P < 0.001). Large‐for‐gestational age fetuses had significantly higher TVol and AVol compared with appropriate‐for‐gestational age fetuses in both the PGD and control groups. Fractional thigh volume (TVol) measured within 7 days before delivery can predict fetal macrosomia with a sensitivity of 81.82% and a specificity of 84.93% at a cut‐off of 82.71 mL. Conclusion Fetal limb fractional volume can be used as a predictor for fetal macrosomia in women having diabetes or normal glucose tolerance. Further investigation implementing automatized methods can improve estimated fetal weight assessment in birth weight extremes.

In Russia as well as all over the world, more and more women are systematically involved in sports. Female athletes are professionally mastering extreme sports, among other things. As is known, high-performance sports are characterized by excessive physical and psychological stress, which can cause dysfunction of various organs and systems. To denote the syndrome that combines disordered eating, amenorrhea, and osteoporosis in women involved in sports, the concept of the female athlete triad was proposed, which was later supplemented by the relatively energy deficiency in sport (RED-S) syndrome. Intense physical activity combined with a lack of energy can lead to pronounced imbalances in hormonal status and basal metabolism, as well as dysfunction of the cardiovascular, immune, and other body systems. One of the modern directions to prevent the female athlete triad may be the use of combined hormonal contraceptives, which is a reliable method of contraception with additional positive effects on the condition of the female body under the influence of intense physical exertion. This article discusses the pathogenetic mechanisms of the female athlete triad, the possibility of using combined hormonal contraceptives to prevent and correct adverse effects on the body, and their impact on athletic performance and the reproductive health of female athletes.

Genetic and hormonal determinants not only define male and female fenotypes. Differences that occur from the early stages of embryogenesis can also cause normal and pathological phenotypic manifestations depending on fetal sex, as well as different predispositions to diseases in the future. Fetal growth restriction is one of the most common causes of perinatal mortality and morbidity in newborns that complicates a significant number of pregnancies. In this review, we summarized and analyzed the recent data posted on the eLibrary and PubMed platforms with reference to the relationship between the sex of the fetus and the development of fetal growth restriction. According to the available data, fetal growth restriction occurs more frequently in female fetuses than in male ones. This is because in pregnant women, the sex of the fetus determines its biological susceptibility to such risk factors for fetal growth restriction as gestational diabetes mellitus, gestational hypertension, preeclampsia, asthma, etc. In a male fetus, the developing placenta is primarily aimed at increasing fetal weight; while for a female fetus, the priority is on the multiple mechanisms that regulate immune protection, adaptability, and rapid response to modifiable adverse effects.

BACKGROUND: Prevention of birth defects in children is a pressing issue. The total Down syndrome screening detection rate depends on the exact adherence to the prenatal examination algorithm and the average age of pregnant women. The introduction of new technologies increases the efficiency of chromosomal abnormality detection during total screening. AIM: The aim of this study was to assess the effect of organizational demographics on the frequency of births with chromosomal diseases, primarily Down syndrome, and to characterize additional factors to be taken into account when implementing a set of measures to prevent and avoid the birth of children with severe, uncorrectable and socially significant diseases. METHODS: This study included the results of a survey of 2,083 women in case of pre- and postnatal diagnosis of chromosome 21 trisomy in St. Petersburg, Russia from 2013 to 2023. Statistical data processing was carried out using standard software. RESULTS: We showed an increase in the average age of mothers and a decrease in the number of newborns in St. Petersburg over the specified period. The data on an increase in the efficiency of the prenatal diagnostics service were obtained, including using non-invasive prenatal testing for the group with an intermediate (from 1/101 to 1/1000) risk after combined screening. We also observed an increase in the timing of invasive diagnosis for prenatal karyotyping and the constant presence of a group of pregnant women who were not registered through city institutions and did not participate in preventive measures. CONCLUSION: From 2013 to 2023, the average incidence of Down syndrome (diagnosed pre- and postnatally) increased from 1/412 to 1/258 newborns. In general, the effectiveness of prenatal diagnosis increased to 94%; however, it is necessary to strive to transfer invasive diagnosis to earlier pregnancy. The average incidence of newborns with Down syndrome remains stable (1/1231).

BACKGROUND: The use of assisted reproductive technology programs to overcome infertility in some cases continues to be the only way to have a child. Unfortunately, the frequency of reproductive loss reaches average values in the population. Endometrial dysfunction is the cause of the abnormal morphogenesis of the gravid endometrium transformation as a significant factor of reproductive loss in assisted reproductive technology programs and habitual miscarriage. AIM: The aim of this study was to compare the morphological features of aborted fetal tissue in non-developing pregnancies of the first trimester that occurred after the use of assisted reproductive technology and in habitual miscarriage. METHODS: This study was conducted on 97 samples of non-developing pregnancy at 5–8 weeks of gestation. Histological examination was performed using standard methods. Immunohistochemical study to evaluate the expression of progesterone-induced blocking factor, stromal cell-derived factor-1, apoptosis-inducing factor, and endothelial marker was performed according to a standard procedure. Digital microscopy was performed on an Olympus BX46 microscope (Olympus Co., Japan) using cellSens 47 Entry software (Olympus Co., Japan). The expression of markers was calculated using the VideoTesT-Morphology 5.2 program (VideoTesT Ltd., Russia), followed by statistical analysis using the SPSS 23.0 (USA) and GraphPad Prism 9 (USA) software packages. RESULTS: With incomplete gravid transformation of the endometrium, we verified a decrease in the expression of progesterone-induced blocking factor and stromal cell-derived factor-1 in the stroma and glands, and an increase in the expression of apoptosis-inducing factor in the glands. In the endometrial glands with full-fledged gravid transformation after IVF, the expression of progesterone-induced blocking factor was higher compared to non-developing pregnancy with habitual miscarriage. Similar data on the expression of stromal cell-derived factor-1 in the stroma and glands and CD34+ in the stroma of the gravid endometrium were obtained by statistical comparison of markers during full-fledged gravid transformation after IVF and habitual miscarriage. CONCLUSION: A decrease in the expression of progesterone-induced blocking factor and stromal cell-derived factor-1 in the gravid endometrium leads to a loss of local immunosuppression and can cause reproductive loss regardless of the method of pregnancy. An increase in the expression of apoptosis-inducing factor in the glands of the gravid endometrium and CD34+ in the endometrial stroma after IVF and in habitual miscarriage indicate pathological activation of angiogenesis and apoptosis.

Evgeny E. Polotsky was one of the leading obstetricians-gynecologists and health care organizers of the first half of the 20th century in Russia. This article tells about his student years, first at Smolensk State University and then at Voronezh State University, and his development as an obstetrician-gynecologist, occurred with the emerging interest in scientific and pedagogical activities. The article briefly describes his dissertation “Autotransplantation of ovaries” for the PhD degree. E.E. Polotsky held senior positions with the Voronezh Medical Institute, including as director from 1932 to 1934. From November 1934, his professional career continued at the Central Institute of Obstetrics and Gynecology, Leningrad, the USSR (currently the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, St. Petersburg, Russia). From 1937 to 1943, E.E. Polotsky as director of the above institute was also engaged in the organization of Evacuation Hospital No. 1015, which assisted the population during World War II and the Siege of Leningrad. Later, on January 10, 1943, in order to carry out a special assignment for the Leningrad Front, E.E. Polotsky left Leningrad for the active army. There he headed the Evacuation Hospital No. 283 of the Central Front, was the chief gynecologist of the Southern Front, then the 4th Ukrainian Front, and from January 1944 to May 1945, he was the chief gynecologist of the Belorussian-Lithuanian Military District. E.E. Polotsky completed his service with the rank of lieutenant colonel of the medical service in April 1945. After being discharged from the army and returning to Leningrad, he continued working at the Central Institute of Obstetrics and Gynecology as a senior research fellow at the Department of Operative Gynecology.

Introduction Mycoplasma genitalium (MG) is a sexually transmitted bacterium of public health importance, associated with genitourinary disorders, and adverse reproductive and perinatal outcomes. Global data on MG prevalence and antimicrobial resistance (AMR) are primarily available from high-income countries, whereas there is a dearth of information from resource-constrained settings including sub-Saharan Africa. Furthermore, international data on MG rates and AMR in the antenatal population are scarce. Understanding MG prevalence and AMR patterns is crucial for developing effective public health strategies and treatment guidelines. The aim of this study was to investigate the prevalence and epidemiology of MG and the presence of macrolide resistance-associated mutations (MRAMs) among pregnant women attending antenatal care facilities in Zambia. Methods A cross-sectional study was conducted at four antenatal care facilities in Nchelenge, Zambia, among 1,021 pregnant women. Vaginal swabs were collected and tested using the Aptima Mycoplasma genitalium assay, Aptima Combo 2 assay and Aptima Trichomonas vaginalis assay on the Panther System (Hologic). MG-positive samples were further analyzed for MRAMs using the ResistancePlus™ MG assay (SpeeDx). Results The prevalence of MG was 12.6% (127 of 1,005 valid samples) among the pregnant women. Only 12 MG-positive women (9.4%) had symptoms of a genitourinary infection, which was similar to the frequency of genitourinary symptoms among MG-negative women (6.1%). The rates of Chlamydia trachomatis, Neisseria gonorrhoeae, T. vaginalis, and HIV seropositivity were 7.4, 8.3, 23.0, and 8.6%, respectively. MG infection was significantly associated with the presence of all other tested sexually transmitted infections and HIV seropositivity: the detection rates of C. trachomatis, N. gonorrhoeae, T. vaginalis, and HIV seropositivity were significantly higher in MG-positive than in MG-negative women (15.1% vs. 6.2, 15.0% vs. 7.5, 32.3% vs. 22.0, and 14.3% vs. 7.5%, respectively). The ResistancePlus™ MG assay detected MG in 66.1% (84/127) of samples positive by the Aptima M. genitalium assay, however, no MRAMs were detected in the 23S rRNA gene for any of these 84 samples. Discussion This study emphasizes the high prevalence of MG among pregnant women in Zambia, but also lack of MRAMs in MG. These findings suggest that azithromycin remains an efficacious treatment option for MG in this population. Nevertheless, continuous surveillance and judicious macrolide use to maintain treatment efficacy are imperative. Further research and sustained monitoring of MG are essential to inform public health strategies and clinical guidelines in Zambia and similar settings worldwide.

BACKGROUND: Autophagy is essential for placenta formation and fetal brain development. Maternal hyperhomocysteinemia is a risk factor for pregnancy complications and may affect autophagy processes. However, the dynamics of autophagy markers are not studied enough so far. AIM: The aim of this study was to assess the dynamics of key autophagy markers in the fetal brain and various parts of the placenta of rats throughout pregnancy under normal conditions and in the presence of maternal hyperhomocysteinemia. MATERIALS AND METHODS: Pregnant Wistar rats were induced with hyperhomocysteinemia by chronic administration of L-methionine. Placental and fetal brain tissues were collected on days 14 and 20 of gestation. Levels of autophagy markers (Beclin-1; phosphatidylethanolamine conjugated form microtubule-associated protein 1A/1B light chain 3B (LC3B-II); lysosomal associated membrane protein 2 (LAMP-2)] were determined by Western blotting. Ultrastructural changes were examined using electron microscopy. RESULTS: In the control group, by the end of pregnancy (gestational day 20) compared to gestational day 14, we observed an increase in LAMP-2 level in the maternal part of the placenta and a decrease in LC3B-II level in the fetal part of the placenta. In maternal hyperhomocysteinemia in the maternal part of the placenta, we found an increase in LAMP-2 level on gestational day 14 and in LC3B-II level from gestational day 14 to gestational day 20. In the fetal part of the placenta, under the same conditions, we observed a decrease in LC3B-II level on gestational day 14 and an increase in LAMP-2 level by the end of pregnancy. In the fetal brain, a decrease in Beclin-1 level from gestational day 14 to gestational day 20 was shown in the both study groups, while under the influence of hyperhomocysteinemia, the levels of the autophagy markers remained unchanged. Under L-methionine load, pathological ultrastructural changes were observed in the fetal part of the placenta and fetal brain at the both time points studied. Normally and under the influence of hyperhomocysteinemia, autophagosomes were found in placental cells on gestational days 14 and 20, while in brain cells, they were only present on gestational day 20. CONCLUSIONS: The data obtained suggest that autophagy activity in the placenta and fetal brain in normal conditions and under maternal hyperhomocysteinemia depends on the gestational age. Changes in the dynamics of autophagy may be a reason for impaired placental formation and dysfunction in hyperhomocysteinemia. The absence of significant changes in autophagy markers in the fetal brain under hyperhomocysteinemia conditions may result from protective mechanisms in the placenta or/and the resilience of autophagy processes in nervous tissue.

Обоснование . Создание экспериментальной модели аденомиоза представляет научный и практический интерес, что позволяет осуществлять оценку эффективности и патогенетически обоснованной терапии аденомиоза в последующем на созданной высоковоспроизводимой модели заболевания. Цель — создать высоковоспроизводимую модель аденомиоза на новорожденных крысах линии Wistar. Материалы и методы . В статье представлен первый этап эксперимента на новорожденных крысах линии Wistar, включающий создание высоко воспроизводимой модели аденомиоза с различными схемами и кратностью введения тамоксифена, разными сроками выведения животных из эксперимента. Для достижения поставленной цели 26 новорожденным самкам перорально вводили блокатор рецепторов эстрогена (тамоксифен в дозе 20 мг) из расчета 1 мг препарата на 1 кг массы тела животного 1 раз в день. Для определения наиболее оптимальной схемы введения тамоксифена животные разделены на четыре группы: 1-я группа ( n = 6) получала препарат со 2-го по 5-й день постэмбрионального развития, 2-я ( n = 8) — с 3-го по 8-й день жизни, 3-я ( n = 7) — дважды (с 3-го по 8-й и с 25-го по 29-й день жизни), 4-я (контрольная; n = 5) — получала воду без лекарственного препарата. Крыс выводили из эксперимента на 16-й, 30-й и 90-й день жизни. Аденомиоз подтверждали по данным морфологического исследования после выведения из эксперимента. Результаты . Тамоксифен для создания модели аденомиоза целесообразно вводить однократно — со 2-го по 5-й день постэмбрионального развития, выводить животных из эксперимента — на 30-й день жизни, когда выраженность заболевания достаточна и подтверждена при морфологическом исследовании. Такая схема воспроизводима, экономически выгодна. Заключение . Создание описанной модели важно для дальнейших исследований применения различных схем, способов и доз альтернативных методов терапии аденомиоза, описанных во второй части эксперимента.

This article provides a comprehensive historical overview of the development of classical obstetrics in Europe and Russia during the 19th century. The concept of classical originated in Europe in the early 19th century and became fundamental to the development of classical obstetrics. At that time, Ernst Bumm was the father of classical obstetrics in Western Europe, while in Russia, Eduard-Anton Y. Krassovsky became the leader and founder of scientific classical obstetrics. Krassovsky founded the first Russian Society of Obstetricians and Gynecologists in St. Petersburg (1886) and the Journal of Obstetrics and Women’s Diseases (1887). The article explores key problems currently faced by obstetrics, highlighting the high prevalence of surgical deliveries. The author emphasizes that pregnancy and childbirth are natural physiological processes that have evolved over centuries to meet the needs of human survival. Therefore, he advocates for promoting natural and high-quality childbirth. He also calls for aligning with global practices by implementing mandatory newborn resuscitation at weeks 24–25 of gestation, which would address various moral, ethical, economic, social, and legal concerns. Furthermore, the article underscores the importance of conducting scientific research with precision to eliminate risks for patients and provides a critical evaluation of certain treatment approaches for postpartum hemorrhage.

Introduction. Simulation training is a basic component of both medical school and postgraduate education, which requires modern education and healthcare systems to evaluate its effectiveness. The purpose of the study: evaluating the effectiveness of the simulation training allowed them to achieve long-term success and increase their prospects. Materials and methods. Search and analysis of world literature data on simulation training and criteria for the effectiveness of medical training was carried out. Results. Recently, there has been a rapid growth in simulation training programs, which requires the formation of criteria and indicators of their effectiveness. During our analysis of the available data, the following criteria for the effectiveness of the training were identified: frequency of attendance, compliance of the course program with its goals and objectives, simulation equipment, comfort level of participants and team work. Conclusion. Simulation training is a bridge between theoretical, fundamental knowledge and real clinical experience. The effectiveness of simulation training programs determines their rapid growth, which, in the face of an increasing number of proposals, obliges us to determine specific criteria and indicators of their effectiveness.

The uterine decidua contains NK cells differing in their characteristics from classical NK cells, as well as other populations of innate lymphoid cells (ILCs). ILC differentiation depends on the active transcription factors: ILC1 is characterized by T-bet expression, ILC2 is defined by RORα and GATA3, ILC3 expresses RORγt and AhR. We analyzed in vitro the expression of transcription factors by NK cells in the presence of trophoblast cells and cytokines and changes in NK cell cytotoxic activity. We used NK-92 and JEG-3 cell lines, which we cocultured in the presence of IFNγ, IL-10, IL-15, and TGFβ. Then, cells were treated with antibodies to AhR, Eomes, GATA-3, RORα, RORγt, and T-bet and were analyzed. We determined NK cell cytotoxicity towards K562 cells. To characterize the functional state of trophoblast cells, we estimated their secretion of TGFβ and βhCG. We showed that in the presence of trophoblasts, the expression of the classical NK cell transcription factors—Eomes, T-bet, as well as RORα, regulating ILC2 differentiation, and AhR, participating in NCR+ ILC3 formation—decreased in NK cells. RORγt expression typical for NCR- ILC3 remained unchanged. IFNγ inhibited AhR expression. IL-10 stimulated an increase in the number of T-bet+ ILC1-like cells. Both IL-10 and IFNγ suppressed RORα expression by NK cells and stimulated TGFβ secretion by trophoblasts. After coculture with trophoblast cells, NK cells reduced their cytotoxicity. These results indicated trophoblast cell influence on the acquisition of ILC1 and ILC3 characteristics by NK cells.

The present article contains the newest ant the most actual version of clinical recommendations “Gestational diabetes mellitus” of the Russian Ministry of Health. This document has been confirmed for the period from 2024 until 2026 year. Gestational diabetes mellitus is widely known as onset of hyperglycaemia during pregnancy that does not responds to criteria of manifesting diabetes mellitus (DM). The time of next revision is 2026 year or earlier if new evidentiary material appear. The present version of clinical recommendation has been created due to collaboration between Russian Association of Endocrinologists and Russian Society of Obstetricians and Gynecologists. The document is finally approved by scientific and practical Council of the Russian Ministry of Health.

The prevalence of type 2 diabetes mellitus (DM2) and obesity in pregnant women is increasing, particularly in those of advanced reproductive age. DM2, arterial hypertension (AH), proteinuria, and renal insufficiency significantly elevate the risk of pregnancy complications, including preeclampsia (PE), preterm birth, cesarean section (CS), congenital malformations, neonatal respiratory and metabolic disorders, and accelerated progression of chronic kidney disease in mothers. This article describes a case of unplanned pregnancy in a 45-year-old woman with morbid obesity (BMI 50.39), AH, DM2, extremely high proteinuria (12 g/day), and pregestational serum creatinine 210 μmol/L. The patient declined medical recommendations for pregnancy termination. She was prescribed insulin detemir and aspart, achieving a target HbA1C level below 6%. Acetylsalicylic acid and enoxaparin were administrated to prevent PE and thromboembolic complications. Antihypertensive therapy was adjusted multiple times based on 24-h blood pressure monitoring. By 26 weeks of gestation, the patient received methyldopa, extended-release nifedipine, and bisoprolol. No PE or fetal growth restrictions was observed. At 36 weeks 4 days of gestation, a planned CS was performed due to breech presentation. A female infant with diabetic fetopathy was delivered with weight 3290 g, height 51 cm, Apgar score – 7/8 points. The postpartum period was uneventful, and both mother and child were discharged at eighth day. The infant remains healthy and is developing normally. The mother was resumed nephroprotective therapy but, by her own decision, was lost to follow-up after six months. It is known she began regular hemodialysis 1.5 years postpartum. A favorable obstetric outcome was achieved through multidisciplinary pregnancy management, complication prevention, and strict glycemic and blood pressure control.

Drug delivery systems enhance drug efficacy while minimizing side effects. Liposomes, as well-studied and clinically approved carriers, offer biodegradability, biocompatibility, and low toxicity, making them suitable for delivering various pharmacological agents. Granulocyte colony-stimulating factor (G-CSF), a key growth factor, has shown therapeutic potential, particularly in infertility treatment. It effectively manages chronic and refractory endometritis by improving endometrial receptivity and increasing embryo implantation success. Studies indicate that G-CSF promotes endometrial growth and enhances the uterine microenvironment, benefiting patients with recurrent implantation failures and chronic endometritis. Encapsulation of G-CSF in liposomes enhances its stability, bioavailability, and controlled release. G-CSF-loaded liposomes were prepared using passive loading via the thin-film hydration method. The size of the liposomes, polydispersity index (PDI), and zeta potential were determined using dynamic and electrophoretic light scattering methods, and the encapsulation efficiency was measured using high-performance liquid chromatography. The morphology of the liposomes was established and confirmed using cryogenic transmission electron microscopy. The cytocompatibility of the G-CSF-loaded liposomes was evaluated on human dermal fibroblasts using an MTT assay. The G-CSF-loaded liposomes had an average particle size of 161.9 ± 9.9 nm, a PDI of 0.261 ± 0.03, and a zeta potential of +2.09 ± 0.10 mV, exhibiting high physical stability during long-term storage at +4 °C and 60% humidity. The passive loading method resulted in a 52.37 ± 3.64% encapsulation efficiency of the active substance. The analysis of cell viability revealed no cytotoxicity toward liposomes loaded with G-CSF and demonstrated a dose-dependent effect on the viability of human dermal fibroblasts. Thus, the obtained data confirm the successful preparation of G-CSF-loaded liposomes. However, to fully understand their effectiveness in biomedical applications, further research is needed, including an evaluation of their effectiveness in vivo. Such studies will help in determining the potential of these formulations for specific biomedical purposes and evaluating their safety and efficacy in living systems.

This review of foreign literature addresses the pressing issue of preventing venous thromboembolic complications in the practice of modern oncogynecologists. It emphasizes the connection between the severity of the oncological process and the frequency of thromboembolic complications, the presence of which predetermines an unfavorable outcome. The review discusses methods for the prophylactic use of anticoagulants, their role in comprehensive therapy, and their interaction with other treatment methods. This work also discusses laboratory techniques for determining markers of oncological diseases and monitoring the treatment being administered. The prospect of a multidisciplinary approach involving geneticists, immunologists, biochemists, and laboratory diagnostics specialists to address issues of prevention and treatment of oncogynecological diseases is considered.

Despite the research conducted in recent years, it remains difficult to assessing the intensity of stress and pain due to the limited ability of newborn children to express discomfort in the absence of verbal communication, and methods for assessing hormonal regulation, metabolism and homeostasis are invasive and unsuitable for continuous monitoring. Objective . To assess the reaction of the sympathetic nervous system in newborns in the early neonatal period, depending on their state of health, by recording electrodermal activity (EDA). Material and methods . During the work, electrodermal activity indicators were monitored in 160 newborns of gestational age 37–40 weeks, who were divided into two groups: Group 1 included 80 healthy newborns, while Group 2 comprised 80 newborns with perinatal pathology. To monitor the indicators of electrodermal activity, the NeonFSC system (manufactured by «VKO Physiomed ») was used, the software of which enables the assessment of the following skin conduction reactions: — spectral power of the skin conduction reaction «IP»; cumulative stress effect DASS; sympathetic dominance index SDI; reactivity index PVI on the distal parts of the limbs of newborns. Results . Perinatal pathology in group 2 newborns was presented by: intrauterine hypoxia/asphyxia at birth (70%), respiratory insufficiency (57.6%), congenital pneumonia (45%), growth retardation and malnutrition (15%), congenital heart defects in the form of ventricular septal defects (12.5%), diabetic fetopathy (7.5%), cephalohematomas and hemolytic disease due to Rh factor incompatibility (5% each). It was found that in newborns of group 2, such pathological electrodermal activity patterns as cumulative stress effect (р=0,0016) and types 3 and 4 of scattergrams were statistically significantly more often than in children of group 1 (р<0,001). Thus, the reaction of the sympathetic department of the vegetative nervous system, obtained as a result of monitoring electrodermal activity indicators, in newborns in the early neonatal period depended on their state of health. Conclusion . The association between pathological electrodermal activity patterns and the severity of neonatal conditions makes it possible to use them as criteria for neonatal distress, which, according to the results of the study, are an increase in the cumulative effect of stress above 75 centiles, as well as types 3 and 4 of the scattering scale.