Perinatology and reproductology: from research to practice

Clinical and analytical evaluation of the effectiveness of postpartum hemorrhage prevention in patients with repeated cesarean section

Serhii Akhrameev — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-01
УДК 618.5-089.888.61-005.1-084-06:618.5-089.888.61

In modern obstetrics, the issue of postpartum hemorrhage prevention is extremely relevant, especially among patients with repeated cesarean section, who are at high risk of complications.
The objective: analysis of the use of various preventive approaches to the prevention of postpartum hemorrhage in patients with repeated cesarean section.
Materials and methods. The study involved 60 patients with at least one previous surgical delivery in history. The study participants were divided into two groups of 30 women each. The gestational age of pregnant women was 37–40 weeks. We considered medical approaches (uterotonics), surgical (compression sutures, balloon tamponade, etc.), and, interestingly, we looked separately at RENIS as a risk assessment tool even before the onset of labor.
Results. During the study, it was found that personalized tactics (especially using RENIS) demonstrated better indicators: less blood loss, fewer transfusions, and generally a calmer postoperative period. In our opinion, this approach is worth including in clinical practice. Postpartum hemorrhage is one of those complications that, it seems, have been known to us for a long time, but they still turn out to be unpredictable in clinical practice. This is especially true for repeated cesarean sections. Here the situation takes on a different scale: we are dealing not only with surgical intervention, but with a patient who already has a surgical history, often with changes in the structure of the myometrium and the risk of complicated placental attachment. For its part, this requires a different approach. Not just «according to the protocol», but taking into account every nuance: how much time has passed since the previous birth, what the scar looks like, what complications have been in the past. That is, we are talking about clinical thinking that begins not in the operating room, but long before it. And, importantly, often it is prevention that becomes the key to avoiding critical situations.
Conclusions. The results of the study indicate the importance of an individualized approach to the prevention of postpartum hemorrhage, where the choice of method should be based on a comprehensive assessment of risk factors and the general condition of the patient. The proposed algorithms of preventive actions demonstrate a positive effect on reducing the frequency of hemorrhagic complications and improving overall treatment outcomes. The study has practical significance for optimizing the tactics of repeated cesarean section and increasing the safety of motherhood.

An algorithm of the ultrasonic monitoring of multiple pregnancy is with the different types of choriality

Serhij Vdovychenko — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-02
УДК 618.344-06:618.255-073.48

Research purpose. To develop on to inculcate the algorithm of the ultrasonic monitoring of multiple pregnancy at the different types of choriality.
Materials and methods. Work is based on the analysis of results of pregnancy in 207 pregnant with twins, from what 137 observed with the use of the developed algorithm and 70 on a standard method, accepted for a singleton pregnanacy. The term of pregnancy was determined from the first day of the last menstruation, taking into account information of bimanual research in women’s consultation and ultrasonic research in the early terms of pregnancy. Depending on character of choriality were selected 2 basic groups: «dichorionic diamniotic twins» - 146 women and «monochorionic diamniotic twins» is a 61 woman.
Results. Active tactic of ultrasonic control in a sub-group 2.1 allowed to improve perinatal indexes due to diminishing of amount of premature births timely diagnostics of pathological conditions of intrauterine fetuses as a fetal growth retardation and violations of hemodynamics in to the fetoplacental complex. It is here necessary to specify, that by reason of preterm delivery in all 6 cases in a sub-group 2.1 there were complications of pregnancy from the side of mother or fetuses the origin of which does not depend on tactic of conduct of pregnancy the health of mother related to the features forming of fetoplacental complex, while in a sub-group 2.2 - 10 (76,9%) from 13 (100%) premature births happened on a background the preterm premature rupture of membranes. Without regard to that the ultrasonic monitoring of the state of intrauterine fetuses at a monochorionic placentation did not allow fully to prevent antenatal losses, however reduced their frequency and allowed to improve the indexes of health of twins which gave birth for the women of sub-group 2.1 against those indexes for the women of sub-group 2.2. In a sub-group 2.1 in one case took place syndrome of sudden death of 2 (2,4%) fetuses which develop normally, in 37-38 weeks, and a 1 (1,2%) fetus died through decompensation of placenta dysfunction in 27 weeks. In the sub-group of 2.2 antenatal 5 fetuses died for 4 expectant mothers: 2 fetuses died in 30 weeks on a background feto-fetal transfusion syndrome, which was not diagnosed at pregnancy, and 3 fetuses with the signs of fetal growth retardation heavy degree died in 36 weeks of gestation in connection with diagnostics of pathological conditions, which was late. In a sub-group 2.1 it is written from a maternity hospital under the supervision of district paediatrician were 54 (65,8%) children, 25 (30,4%) children were transferred for the subsequent nursing in a children’s hospital, from them 3 (3,7%) needed intensive therapy. In a sub-group 2.2 it is written from a maternity hospital under the supervision of district paediatrician there were 8 (20%) children, 27 (67,5%) children were transferred for the postnatal care in a children’s hospital, from them 14 (35%) needed intensive therapy. Reliable (р<0,05) differences have the indicated information.
Conclusion. The developed algorithm of supervision allowed to improve the perinatal results of multiple pregnancy. Timely correction of cervical insufficiency shortened the percent of premature births, that resulted in the improvement of indexes of the state at birth, adaptation and neurological health of new-born. In addition, early diagnostics of violations of the state of fetus allowed to choose the most optimum obstetric tactic and improve the result of pregnancy for fetuses with fetal growth retardation.

Prophylaxis of early losses of pregnancy, analysis of motion of pregnancies and results of births for women from hyperandrogenism

Serhij Vdovychenko — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-03
УДК 618.3/.5-036.1-06:612.616.31:618.39-084

Research purpose. To develop the algorithm of prophylaxis of early losses of pregnancy, obstetric and perinatal pathology for women from hyperandrogenism.
Material and methods. We are inspect 380 patients with violation of generative function (infertility is primary, second, early losses of pregnancy) on a background the clinical and biochemical displays of hyperandrogenism. In research appeared plugging criteria: violation of generative function (infertility, early losses of pregnancy) and clinical displays of hyperandrogenism. Initially all 380 investigated patients parted on two groups depending on concomitant obesity, as viscelar adipose tissue plays not only an important role in the biosynthesis of sexual steroids but also to development of peripheral insulinoresistance and, as a result, hyperinsulinemia. Group I: 163 patients from hyperandrogenism and by normal mass of body (body mass index < 25) in age from 23 to 35 years, middle age made 27,5±2,5. Group II: 217 patients from hyperandrogenism and by viscelar obesity in age from 24 to 36 years, middle age made 28,1±2,1. A control group was made 30 practically healthy women of reproductive age (middle age 27,9±1,9), from them 15 – with normal mass of body (body mass index <25, middle age 27,2±1,8) and 15 – from exogenic-constitutional obesity (body mass index >25, middle age 26,7±2,1). At an inspection studied complaints and anamnesis of disease, and then conducted the extraclinical and special methods of research.
Results. Pregnancies made off urgent births in 98,1% (n=312). At the analysis of methods of delivery for women from hyperandrogenism the high percent of operations is marked caesar section - 33,6% (n=107). Certificates served as: persistent weakness of childbirth which is not added to medicinal therapy (18,7%), anatomic narrowing of pelvis, wrong position of fetus (4,7%), heavy gestosis (7,3%). Last 68% (n=73) operative delivery is conducted pregnant on the sum of relative certificates, taking into account duration of infertility in anamnesis. 2 pregnant pre-schedule delivery was needed: 1 - concerning decompensation of placenta dysfunction in a term 34-35 weeks pregnancies, and 1 – concerning a heavy gestosis which does not respond to treatment in a term 36-37 weeks pregnancies. The state of new-born was estimated on the set parameters. In the inspected groups of cases of mortinatality discovered it was not. Children gave birth with an estimation after a scale Apgar 8-10 points, by middle mass 3240±280 grammes. Defects of development of fetuses discovered it was not.
Conclusion. Pregnancy which came for patients from hyperandrogenism after treatment of infertility and especially after induction of ovulation, behaves to the group of high risk on miscarriage and development of complications of motion of pregnancy. Therefore tactician of conduct I to the trimester of pregnancy of this group of patients must be directed on a prophylaxis, early exposure and treatment of threat of terminating pregnancy, placenta dysfunction and gestosis. At uncomplicated of pregnancy is conducted correction in ambulatory terms, on the testimonies of patient hospitalized in permanent establishment. The complex going near the conduct of pregnant of high group of risk allows to reduce frequency of miscarriage. At that rate it is possible to consider not only achievement of pregnancy success of treatment but also happy to its motion with subsequent birth of healthy child. That, birth of viable children was 98,1%.

Features of pathogenesis of the intrauterine infection

Andrey Prishchepa — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-04
УДК 618.33-022.7-053.1-092-039

Research purpose. To learn the features of pathogenesis of the intrauterine infection.
Materials and methods. For the decision of the put purpose the followings groups of patients were formed: in a 1 group entered 111 pregnant with the presence of antibodies of class of G to Chlamydia of trachomatis in a title 1:5-1:40, without the clinical displays of disease in mothers, with the signs of the intrauterine infection from the term of pregnancy 18-20 weeks, without antibacterial therapy during pregnancy, inspected in a term 13-24 weeks and in 38-40 weeks of gestation. 2 groups were presented 45 pregnant with the presence of high-avidity antibodies of class of G to Herpes of simplex 1,2 without the clinical displays of which or disease in mothers, with the signs of the intrauterine infection from the term of pregnancy 18-20 weeks (polyhydramnios, fetal growth retardation, thickening of placenta, suspension in amniotic fluid and ets), without medicinal therapy during pregnancy, inspected in a term 38-40 weeks gestation. 3 groups were made 45 pregnant with the presence of Candida of albicans 104-106 CFU/l, without the clinical displays of infectious disease in mothers, with the signs of the intrauterine infection from the term of pregnancy of 18- 20 weeks (polyhydramnios, fetal growth retardation, thickening of placenta, suspension in amniotic fluid and ets), without medicinal therapy during pregnancy, inspected in a term 38-40 weeks gestation. Delivery through natural birth canal in the term of gestation 38-40 weeks. 4 groups consisted of 43 pregnant from Staphylococcus of aureus, without the clinical displays of infectious disease in mothers, with the signs of the intrauterine infection from the term of pregnancy 18-20 weeks (polyhydramnios, fetal growth retardation, thickening of placenta, suspension in amniotic fluid and ets), without medicinal therapy during pregnancy, inspected in a term 38-40 weeks gestation. Delivery through natural birth canal in the term of gestation 38-40 weeks. A to 5 group entered 157 pregnant transmitters of exciters of mixt-infection, without the clinical displays of infectious disease during all pregnancy, with the signs of the intrauterine infection from the term of pregnancy 18-20 weeks (polyhydramnios, fetal growth retardation, thickening of placenta, suspension in amniotic fluid and ets), without antibacterial therapy during pregnancy, inspected in a term 38-40 weeks gestation. Delivery through natural birth canal in the term of gestation 38-40 weeks.
To the complex of the conducted researches were included clinical, echographic, laboratory, microbiological and statistical methods. From laboratory indexes the special attention was spared to determination content alpha-2-macroglobulin, to the lactoferrin and albumen in blood and amniotic fluid.
Results. For all puerperas with the transmitter of exciters perinatal meaningful infections in mixtures and birth of children with a intrauterine infection found out the meaningful decline of indexes of albumen in the whey of blood as compared to control which testifies to the presence of inflammatory processes. Table of contents of albumen in amniotic fluid of puerperas with the mixtures transmitter of exciters perinatal meaningful infections was analogical to content at mono-carriage of the studied exciters of infections in sub-groups, where necessarily there were antibodies to Her. Simplex, and also St. Aureus or Can.albicans, however, if at mono-carriage of IgG of antibodies to Chlamydia of trachomatis increase of level of albumen was frequent, then at mixtures of contagiums these changes absented actually. At an analysis each of variants of mixtures found out that the most considerable changes were observed at mixtures of Candida of albicans with the transmitter of IgG Herpes simplex 1,2 or Chlamydia of trachomatis. Like and at the analysis of the mixed groups the most considerable changes are fixed in the case when in composition mixtures necessarily there was Candida of albicans. On the whole, levels of albumen in amniotic fluid at the transmitter of mixtures of exciters perinatal meaningful infections were enhanceable at the transmitter of all exciters, except for Staphylococcus of aureus.
Conclusion. The transmitter of exciters in mixtures amends in pathogenesis of processes which take place at mono-carriage exciters of infections. Especially notedly it at comparison of mono-mixtures-carriage of Chlamydia of trachomatis. However on the whole, changes of indexes of immunoregulatory albumens for pregnant and puerperas at the risk of birth of children with the intrauterine infection at a mixtures transmitter analogical such at mono-carriage, that is why can be used in clinical practice for the prognosis of the intrauterine infection, complicated by the infectious process of motion of early neonatal period in new-born.

Factors of risk of gestational increase of mass of body for women different age

Andrey Semenyuk — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-05
УДК 618.3/5-056.5-055.2-06

Research purpose. To set the factors of risk of gestational increase of mass of body for women different age.
Materials and methods. Cohort study is conducted 529 patients which were on an account concerning pregnancy in antenatal clinic. 356 women were plugged the method of continuous selection in retrospective research and 173 - in prostective. The criteria of including served as: age more senior 18 years, anamnestic and laboratory null, indicative on saccharine diabetes, absence of severe somatic pathology data. Criteria of exception: multiple pregnancy, termination pregnancy to 37 weeks gestation, gestational diabetes. All women designed the «Informed consent to participating in research».
Results. Conducting the analysis of gestational dynamics of weight, we found out, that surplus or lack of gestational increase of mass of body was mortgaged already in a 1 trimester. Increase of primary mass more, than on 2,5 kg increases the risk of surplus raise almost at 2,5 time (relative risk = 2,4, 95% confidence interval 1,3-4,0; р<0,05). And vice versa, those women which lost mass and did not pick up thread it to 12 weeks, with the same authenticity risk to increase not enough the weight (relative risk =2,4, 95% confidence interval 1,2-5,1; р<0,05). However because in practice initial not mass of woman, but its value, is fixed at the first appearance (on the average on 8-9 week), the «collected kilograms» often are not taken into account, that results in diagnostic errors: a diagnosis is set only to the end of the second to the trimester, when already difficultly be that cardinal to change.
In addition, the traditional going near determination of increase of mass (a difference of mass is between two appearances of woman in consultation) can mislead a doctor, as feel like considerable vibrations. The insufficient informing of similar method induced us to develop gravigram, that allow objectively to estimate gestational gain in weight for patients with different mass and in good time to appoint measures which correct.
Conclusion. In modern terms the pathological increase of mass of body (insufficient and surplus) belongs to the frequent states which are registered during pregnancy. Risk factors: inadequate feed pregnant, smoking, pregravid violation of lipid exchange, incomplete proceeding in mass of body after previous births.

Comparative aspects of the functional state of the system are a motherplacentafetus at the antenatal fetal hypoxia

Olena Susidko — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-06
УДК 618.33-001.8:618.3/.36-008-07

Research purpose. To estimate the comparative aspects of the functional state of the system mother-placenta-fetus at a antenatal hypoxia.
Materials and methods. A basic (1th) group was made by 55 cases of death of fetus from a antenatal hypoxia in terms of 23-40 weeks at a singleton pregnancy: 55 placentas and 52 fetuses (in 3 cases a section was not produced). These 55 the most difficult for diagnostics supervisions of antenatal fetal death were included by us in a 1 group of research on the basis of the unspecified nosotropic role of placenta and not clear tanatofenesis, they were 52% all antenatal losses. Cases of antenatal death of the set etiology - with infectious fetopathy, by innate teratosiss, incompatible with a antenatal period, - from research eliminated, as well as multiple pregnancy. Three groups of comparing to birth living new-born, without regard to threatenings lives of fetus will become a draught pregnancies, formed on the basis of clinical estimation of weight of placenta dysfunction and result of pregnancy, – all investigational 46 placentas of new-born in terms of 25-40 weeks at a singleton pregnancy. To the complex of the conducted researches were included clinical, echographic, doppler, cardiotocographic and statistical.
Results. Placenta dysfunction is compensated with the worn pregnancy and favourable perinatal result characterized by the low levels of placenta lactogen (Me=5,8 P) and estriol (Me=0,7 P) at mean values levels of progesterone, alpha-fetoprotein and cortisol, by the low biometrical fetal parameters – biparietal diameter of head (Me=10 P), diameter thorax (Me=15 P) and abdomen (Me=10 P) at the mean values of length of femur (Me=54,25 P) and thickness of placenta (Me=71,3 P), by most frequency of fetal growth retardation II-III of degree and oligohydramnios. The pregnant of this group are younger (Me=24 years) in all, without predominance of severe preeclampsia in a nosology spectrum.
Conclusion. A comparative estimation is conducted clinical-and-functional features of the system mother-placenta-fetus at a antenatal hypoxia from without and with fetal losses. The got results must be taken into account at development of algorithm of diagnostic and treatment-and-prophylactic measures.

Dynamics of childbirth and hypertensive disorders that occurred during pregnancy in Ukraine (2022–2024)

Artem Chernov — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-07
УДК 618.3-06:616.24:616.12-008.331

The objective: to conduct a retrospective statistical analysis of the dynamics of childbirth and hypertensive disorders that occurred during pregnancy in Ukraine from 2022 to 2024.
Materials and methods. Data were taken from the Center for Public Health of Ukraine, the Center for Medical Statistics of the Ministry of Health of Ukraine, namely the Report on Medical Care for Pregnant Women, Parturient Women and Women in Labor from 2022 to 2024, data from form No. 21, table F212210 (obstetric care in a hospital) and table F212130 (during pregnancy - individual diseases that were or occurred during pregnancy and complicate pregnancy, childbirth and the postpartum period). Statistical processing of research results was carried out using standard programs "Microsoft Excel 7.0" and "Statistica 8.0"
Results. The number of births in Ukraine from 2022 to 2024 decreased by 16,897 births, the number of physiological births from 62.9% in 2022, 60.3% in 2023 to 60.2% of cases in 2024. The number of pathological births, over the three years of martial law in Ukraine, increased from 37.1% of cases in 2022, 39.7% in 2023, and 39.8% in 2024. The total number of women in Ukraine who gave birth for the first time, unfortunately, has a tendency to decrease: from 2022 to 14,634 births. Analyzing the frequency of hypertensive disorders during pregnancy over the 3 years of the war, there has been an increase in this complication of pregnancy - in 2022 8.9% of cases, in 2023 10.2% of cases, and in 2024 11.2% of cases.
Conclusions. Analysis of the dynamics of childbirth in Ukraine demonstrated a decrease in the frequency of childbirth, an increase in the proportion of pathological childbirth, a decrease in the number of women giving birth for the first time from 2022 to 2024. The number of cases of hypertensive disorders that developed during pregnancy increased from 8.9% of cases in 2022 to 11.2% of cases in 2024 across Ukraine.
The principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper.
No conflict of interests was declared by the authors.

Women have medicalandsocial features after subtotal hysterectomy

Serhij Vdovychenko — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-08
УДК 618.14-089.873-089.853-031:611.67]-058-039

Research purpose. To estimate medical-and-social features for women after subtotal hysterectomy.
Materials and methods. For determination of medical-and-social features there was the conducted inspection 100 women with the stored menstrual cycle in age from 40 to 50 years, in which in the conditions of gynaecological permanent establishment subtotal hysterectomy was conducted. From them in 50 women subtotal hysterectomy was combined from tubectomy – these patients made a basic group, 50 women which salpinxs were stored in entered in the group of comparison. To the complex of the conducted researches clinical, social, laboratory and instrumental methods were included.
Results. The women of the investigated groups have the conducted analysis of operative interference. More frequent all to the operation a uterine fibroids appeared a testimony with a hemorragic syndrome in 25 (50,7±4,3%) in a basic group and in 27 (54,4±4,7%) in the group of comparison. A large of tumour with the parafunction of nearby organs was a testimony to the operation in 6 (12,6±1,2%) women of basic group and in 5 (9,8±2,8%) women in the group of comparison. Development of pain syndrome for patients with a uterine fibroids in default of effect from conservative therapy served as a testimony to operative treatment in 9 (17,9±1,3%) in a basic group and in 7 (13,4±1,2%) in the group of comparison. Hasty growth of tumour which requires operative interference found out in 5 (8,9±0,5%) patients of basic group and in 7 (13,4±1,2%) in the group of comparison. Adenomyosis, that is accompanied by a pain and hemorragic syndrome, was a testimony for 3 (5,9±0,2%) women of basic group and for 3 (6,3±0,3%) women in the group of comparison. Recurrent endometrial hyperplasia served a testimony to operative treatment for 2 (3,7±0,4%) women in a basic group and in 1 (2,6±0,2%) in the group of comparison.
Conclusion. The results of the conducted researches testify that for women after subtotal hysterectomy medical-and-social features take place at the estimation of level of somatic and concomitant genital pathology, reproductive function on methods of previous treatment. Set medical-and-social features must be taken into account at development of algorithm of diagnostic and treatment-and-prophylactic measures.

Women have features of function of ovaries with the plural hyperplastic processes of organs of the reproductive system

Iryna Netskar — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-09
УДК 618.17/.5-007.61-02:618.11-039

Research purpose. To estimate the features of function of ovaries for women with the plural hyperplastic processes of organs of the reproductive system.
Materials and methods. For the decision of the put purpose 74 women are inspected. To the basic group entered 54 patients with two and by more hyperplastic processes of organs of the reproductive system (uterine fibroids, hyperplasia and endometrial polyps, adenomyosis, external genital endometriosis, fibro-cystic mastopathia). A control group was made by 20 women from ovulatory menstrual cycle, middle duration of 28,4±0,8 day. Except for clinical and echographic methods, for research to the function of ovaries determined maintenance in blood of estradiol on 5-7 day of menstrual cycle, progesterone on 20-24 days of menstrual cycle.
Results. Depending on character of menstrual cycle, the most high maintenance of estradiol as compared to an analogical index in the group of control was observed for women with anovulation - 298,2±11,7 pmol/l (р<0,05). The level of progesterone in blood of patients of basic group with a valuable ovulatory cycle (43,8±4,6 nmol/l) was comparable with the index of control group (45,1±4,9 nmol/l, р>0,05). At insufficiency of luteal phase of menstrual cycle a level of progesterone was more than in two times below (18,8±1,1 nmol/l) than for women with a ovulatory cycle (43,8±4,6 nmol/l, p< 0,01) and in a control group (45,1±4,9 nmol/l, p< 0,01).
Conclusion. Findings pictures confirm and complement of nosotropic role relative and absolute hyperestrogenemia in development of plural hyperplastic diseases of organs of the reproductive system. Findings must be taken into account at development of algorithm of diagnostic and treatment-and-prophylactic measures for women with the plural hyperplastic processes of endometrium.

Features of endocrinological and immunological status at gynaecological morbidity for women with connective tissue dysplasia

Kateryna Pavlova — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-10
УДК 618.1-018-007.17:616.43/.45-07:612.017]-039

Research purpose. To learn the features of endocrinological and immunological status at gynaecological morbidity for women with connective tissue dysplasia.
Materials and methods. To implement our goals by us an inspection and treatment was conducted 688 patients reproductive, pre- and postmenopausal periods. In accordance with a purpose and research tasks four groups of patients were plugged in the real work, in each of which selected a group with connective tissue dysplasia and without it. Clinical, laboratory, instrumental and statistical methods were plugged in the complex of the conducted researches.
Results. At the comparative analysis of indexes of immune status for patients with connective tissue dysplasia and without it, it is possible to draw conclusion, that the results of IgG and IgA in both groups do not differ practically. Women have levels of IgМ a bit higher with connective tissue dysplasia. The most meaningful differences are at comparison of results of IgЕ, circulatory immune complexes, C3- and C4-component of complement. Amount of IgE for the patients of reproductive period with pathology of connecting fabric almost at 1,5 time more than for patients without connective tissue dysplasia. For the women of pre- and postmenopausal periods with connective tissue dysplasia fabric except for the reliable increase of level of IgЕ the increase of amount of circulatory immune complexes is marked at 1,8 time, decline of C3- C4-component to complement respectively in 1,8 and 1,5 times.
Conclusion. At insignificant changes in the indexes of immune status there is not a necessity for setting of immunomodulatory therapy. And only at considerable changes and in the case of worsening of indexes of immune status during a dynamic supervision it is necessary to decide a question about setting of immune preparations. Findings must be taken into account at development of algorithm of treatment-and-prophylactic measures.

Differential diagnostics of benigh and malignant hyperplastic processes of endometrium for women different age

Yuliya Strakhovetska — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-11
УДК 618.14-031:611.664]-002.18-006-079.4

Research purpose. To develop differential diagnostics of benigh and malignant hyperplastic processes of endometrium.
Materials and methods. All patients which entered in research parted on three groups of comparison depending on character of pathology of endometrium: I a group is 138 patients with the of benigh hyperplastic processes of endometrium; The II group is 509 patients with the cancer of endometrium part on three sub-groups: IIа - 200 patients from highly differentiated adenocarcinoma; IIв - 171 sick with moderately differentiated adenocarcinoma; IIс - 138 patients with low-grade differentiated adenocarcinoma; The III group is 67 patients without pathology of endometrium.
The laboratory methods of researches were included by biochemical, endocrinology and immunological indexes.
Results. At comparison of information of hysteroscopy with the results of histological research of operating material, divergence of diagnoses was marked only in 4 (2,9%) cases. At histological research of these cases simple hyperplasia was verified, that glandular hyperplasia of endometrium. We defined that than higher degree of differentiation of adenocarcinoma of endometrium, the more so the amount of cases of discrepancy of diagnoses (mainly toward false-positive diagnostics of benigh hyperplastic processes of endometrium) is marked and vice versa, - diagnostic exactness, specificity and test-sensitivity, grow as far as diminishing of degree of differentiation of malignant tumour of uterus. It was also set that specificity, sensitiveness and diagnostic exactness of hysteroscopy higher at diagnostics of benigh hyperplastic processes of endometrium, what at diagnostics of malignant processes of cavity of uterus. Consequently, we are set high specificity (from 81,6% to 95,4%), sensitiveness (from 78,2% to 91,2%) and diagnostic exactness (from 82,4% to 95,8%) of method of benigh on the stage of preoperative diagnostics at the of benigh hyperplastic processes of endometrium and by a endometrial cancer.
Conclusion. Combined use of hysteroscopic and ultrasonic information, and also indexes of intracellular metabolism of enzymes, lipid peroxidation and antioxidant system, is the high-informing methods of differential diagnostics of benigh and malignant hyperplasia of endometrium on preclinical and pre-hospital stages.

Conformities to law of forming compensatoryadaptive reactions of the psychoemotional state and difference in the mechanisms of their realization at the different forms of diffuse dishormonal dysplasia of mammary glands

Natalia Sukhostavets — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-12
УДК 618.19-007.17:612.621.31]-003.96-036:159.922.27

Research purpose. To estimate conformities to law of forming compensatory-adaptive reactions of the psychoemotional state and difference in the mechanisms of their realization at the different forms of diffuse dishormonal dysplasia of mammary glands.
Materials and methods. Research material information, got at an inspection 120 patients with diffuse dishormonal dysplasia of mammary glands, served as. Appeared the criteria of including presence of diffuse dishormonal dysplasia of mammary glands; absence of nodular forms of dishormonal dysplasia of mammary glands; age from 18 to 45 years; a reproductive function is preserved; the informed consent is to participate in research. A control group included 30 somatically healthy women, comparable with a basic group on age. On the first stage of research patients were up-diffused on 4 clinical groups with diffuse dishormonal dysplasia of mammary glands with predominance of glandular (I group), cystic (II group), fibrotic (III group) component and mixed form (IV group). Diffuse dishormonal dysplasia of mammary glands in accordance with modern criteria was diagnosed on the basis of complaints, information of anamnesis, estimation of general and gynaecological statuses, ultrasonic scan-out of mammary glands. To the complex of methods of researches clinical, laboratory instrumental and statistical methods were included.
Results. It is set that diffuse dishormonal dysplasia of mammary glands forms the different from the state of health structure of cross-correlation matrix – structure of the homoeostatic adjusting with participation of all analysable parameters. Thus to every form of mastopathy peculiar certain features of their intercommunications. In providing of homoeostasis for glandular, cystic and mixed forms indisputable is priority of regulator influences of the vegetative nervous system. Here «enriching» of connections of the system of the vegetative providing of functions and realizing for stress hormones comes forward an of principle difference meaningfulness at a cystic form and practically even number of connections which are on a heterospecific and specific hormonal type at glandular and mixed forms. The function of system-organizing structure in a group with a fibrotic form passes to the contour of realizing for stress and specific hormones. Some differences of expressed of parameters of thyroid hormonal status are marked in providing of the proper level of homoeostasis in groups from diffuse dishormonal dysplasia of mammary glands. It is known that a hypothyroidism which is accompanied by the increase of level of thyrotropic hormone is instrumental in the increase of content of prolactin, due to strengthening of secretion of thyroliberin. Pathology of thyroid causes the change of functioning of vegetative nervous system, here, more frequent there is strengthening of activity of a stress, likable department. The most expressed (as compared to control) participating of this homeostat in support of optimum of vital functions is determined for patients with the glandular and mixed form of mastopathy, less expressed – with a fibrotic and cystic form. However, the basic difference of structural organization of the systems of life-support in a number of different clinical-and-morphological forms of mastopathy is «tension» in the investigational systems, that increases, it appears in growth of number of meaningful connections between the separate constituents of homoeostasis.
Conclusion. It is set that consider the changes of specific hormonal activity the basic nosotropic link of origin and progress of mastopathy. Therefore priority direction in treatment of diffuse dishormonal dysplasia of mammary glands is a hormonotherapy the conduct of which does not change the condition of support of homoeostasis, that formed. In same queue, the correction of vegetative violations can be carried out by facilities which own adaptogenic properties.

Features of medicalandsocial factors during a conduct organpreserving operations for the women of reproductive age

Olha Tkachenko — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-13
УДК 618.17/.5-006-018-089-039:614.2

Purpose. To investigate medical-and-social factors during a conduct organ-preserving operations for the women of reproductive age.
Materials and methods. As a result of clinical-and-statistical research of primary medical document of gynaecological permanent establishment of copies information from 520 medical histories of gynaecological patients, which was executed functionally-sparing operations. A structure and dynamics of gynaecological diseases was analysed, the specific weight of organ-preserving operations was determined with the different types of accesses and volume of surgical treatment. From this group of gynaecological patients a basic group (224 women) and group of comparison (108 women), which parted on 2 sub-groups (after radical operations and after conservative therapy), was selected (with the observance of rules of statistical and clinical selection), comparable on age, by the stage and severity of disease. Plugging criteria in a basic group were women with specific gynaecological diseases (prolapsus of front and back wall of vagina II, III degree, from the elongation of cervix, cystocele and rectocele; by the uterine fibroids of different form and sizes (to 16–17 weeks pregnancy); of high quality formations of appendages of uterus and by the ovarian apoplexy for the women of reproductive period).
Results. By us the presented analysis of structure of hospitalized on operative treatment, analysis of dynamics clinical-and-functional the states and efficiency functionally sparing gynaecological operations. In the structure of the women hospitalized for surgical treatment, greater specific gravity was made by patients with of high quality formations of appendages of uterus (36,6%), with the prolapsus of front and back wall of vagina II, III degree (30,4%), with the uterine fibroids of different form and sizes (20,9%) and with the ovarian apoplexy (12,1%). Results clinical and clinical-and-statistical it is testified an analysis, that in 33,0% women with pelvic organ prolapse II-III of degree reconstructive-rehabilitation operations are executed by vaginal access; Manchester operation (76,3%); anterior and posterior colporrhaphy, cystopexy, urethral fixation, pelvic floor muscle recovery (23,7%). With uterine fibroids a conservative myomectomy (21,0%) is executed women, Pfannenshtiel incision (97,8%). Organ-preserving operations for women with of high quality formations of appendages are executed mainly by a laparoscopic method (97,3%), including: cystectomy (46,7%); ovarian resection (26,6%); adnexectomy (12,4%); cystectomy from one side and ovarian resection on the other side (11,4%). Functionally sparing operations on the uterine appendages were 66,6% from all conducted operations.
Conclusion. A comparative analysis is conducted clinical-and-functional the states for women on the different stages of supervision testifies that more than half of gynaecological patients (53,4%) grumbled about the presence of pain syndrome at the bottom of stomach of different intensity. Found out the protracted terms of display of pains to hospitalization (during a month to hospitalization of pain marked 61,3% women, and 15,3% marked during anymore half-year). In 6 months after an operation periodic pains which heave up, at the bottom of stomach 24,7% women marked only, and in a remote period – there are 18,6% women. Almost in the halves of patients (45,2%) violation of menstrual cycle is marked in anamnesis, and 31,9% women of violation of menstrual cycle disturbed more than 6 months. Findings must be used for the conduct of diagnostic and treatment-and-prophylactic measures.

Personalized Strategies for Fertility Preservation in Women with Chronic Urogenital Infections: From Immunomodulation to Assisted Reproductive Technologies

Svitlana Nagirniak — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-14
УДК 618.177-022.7-092:612.017:577.27:615.832.9-085:616-08-039.71

Abstract Background. Infectious infertility is one of the leading challenges in modern reproductive medicine, characterized by a high rate of implantation failures and recurrent inflammatory processes. Chronic urogenital infections affect not only the local microbiome but also immune and molecular pathways, leading to cytokine imbalance, reduced endometrial receptivity, and the development of oxidative stress. This highlights the need for new personalized treatment strategies aimed not only at eliminating the pathogen but also at restoring immune homeostasis and endometrial functionality.
Objective. To evaluate the effectiveness of personalized fertility-preservation strategies in women with chronic vulvovaginal and cervical infections, taking into account the immunological profile, microbiome status, oxidative stress levels, and markers of endometrial receptivity, as well as to determine the role of ozone therapy and antioxidant support as adjuvant methods in preparation for assisted reproductive technology (ART) programs.
Materials and methods. A total of 150 women of reproductive age with infertility of infectious origin were examined. All patients underwent comprehensive assessment, including microbiological testing (Lactobacillus spp., Gardnerella vaginalis, Candida spp.), immunological evaluation (IL-6, IL-8, TNF-α, CD8⁺), hormonal testing (AMH), assessment of cervical mucus quality (Insler score), and endometrial biopsy with determination of HOXA10 and LIF expression. Patients were stratified by type of infection and treatment protocol: standard therapy; standard therapy plus ozone therapy; standard therapy plus ozone therapy combined with antioxidants.
Results. The addition of ozone therapy resulted in a significant decrease in proinflammatory cytokines (IL-6 by 44%, IL-8 by 39%, TNF-α by 41%), increased cytotoxic activity of CD8⁺ lymphocytes, and normalization of the microbiome (increase in Lactobacillus spp., decrease in Gardnerella vaginalis). The inclusion of antioxidant support provided an additional reduction in malondialdehyde (MDA) levels and an increase in superoxide dismutase (SOD) activity, which was associated with restoration of HOXA10 and LIF expression in the endometrium. The clinical pregnancy rate within 6 months after treatment was highest in the combined therapy group (73% vs. 45% in the control group, p < 0.01).
Conclusions. Chronic urogenital infections lead to profound immunological, microbiological, and molecular disturbances that impair women’s reproductive potential. A personalized approach that considers cytokine profile, oxidative stress, and endometrial receptivity markers makes it possible to optimize treatment, improve ART outcomes, and reduce the recurrence of infections. Ozone therapy in combination with antioxidants represents a promising pathogenetically justified component of comprehensive therapy for infertility of infectious origin.

Criteria of estimation of significance of differences of results depending on matrimonial pair have actions of risk factors at infertility

Andrey Shchedrov — 2025-10-17

DOI: 10.52705/2788-6190-2025-3-15
УДК 618.177-068.833-06-036.8

Research purpose. To set the criteria of estimation of significance of differences of results depending on the action of risk factor at infertility at matrimonial pair and application of donor oocytes.
Materials and methods. In obedience to the put purpose 135 women were up-diffused on three clinical groups. In a basic group women were plugged with making progress pregnancy after the oocyte donation (n=32). In a group comparisons are women with making progress pregnancy after in vitro fertilization without the donor programs (n=53). A control (n=50) group was formed with including de bene esse of healthy women with spontaneously coming pregnancy in the natural menstrual loop, with the physiological course of pregnancy and births. Plugging criteria in a basic group: reproductive age, desirable pregnancy, application of oocyte donation because of reductions ovarian reserve. Plugging criteria in the group of comparison: reproductive age, desirable pregnancy, application of assisted reproductive technologies without the oocyte donation. Criteria of exception for all groups: surrogacy, other testimonies for the oocyte donation, except for reductions ovarian reserve, obstetric or extragenital pathology with the high risk of decompensation. Clinical, laboratory, instrumental and statistical methods were plugged in the complex of the conducted researches.
Results.It turned out at the analysis of reproductive anamnesis, that only in 6% women of the II group there were involuntary abortions in anamnesis. Women from oocyte donation, more credible than all, did not have abortions in anamnesis through considerable violations of reproductive function, that appeared reason of primary infertility in 72% women. Reliable difference in an amount the attempts in vitro fertilization discovered it was not. That for women which requested the oocyte donation, frequency of unsuccessful attempts in vitro fertilization did not excel such as compared to women without the oocyte donation. A maximal number of attempts in vitro fertilization women with the oocyte donation had 7, Me=2, and for women with in vitro fertilization without the oocyte donation maximal number of attempts in vitro fertilization– 6, Me=1. However, a mean value appeared comparable for the women of both groups: 2,74±0,3 vs. 2,23±0,27, р>0,05. Without regard to that for women from oocyte donation for certain more frequent found out in anamnesis factors which influence mainly on the endocrine adjusting of reproductive function, at the analysis of predictable reasons of infertility, which requested assisted reproductive technologies, reliable difference it was not discovered also (р>0,05). For women with in vitro fertilization, independent of necessity of oocyte donation, frequency of exposure tuboperitoneal, endocrine or mixed factor of infertility were comparison.
Conclusion. It is impossible simply to provide for, which motion of pregnancy will be, if it was planned, desired, such, which came on a background the reception of female sex hormones, improvement of the states of rheology and aggregate to blood, prophylaxises of deficit of folic acid and hyperhomocysteinimia (I-II of group), or that came spontaneously, it is not planned, in 82% women de bene esse healthy, but off preconception preparation. The got results must be taken into account at development of algorithm of diagnostic and treatment-and-prophylactic measures.

Perinatology and reproductology: from research to practice

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Features of medical­and­social factors during a conduct organ­preserving operations for the women of reproductive age

Personalized Strategies for Fertility Preservation in Women with Chronic Urogenital Infections: From Immunomodulation to Assisted Reproductive Technologies

Criteria of estimation of significance of differences of results depending on matrimonial pair have actions of risk factors at infertility

Comparative aspects of the functional state of the system are a motherplacentafetus at the antenatal fetal hypoxia

Women have medicalandsocial features after subtotal hysterectomy

Conformities to law of forming compensatoryadaptive reactions of the psychoemotional state and difference in the mechanisms of their realization at the different forms of diffuse dishormonal dysplasia of mammary glands

Features of medicalandsocial factors during a conduct organpreserving operations for the women of reproductive age