Tamara Yarygina

The publication is devoted to the Dopplerographic examination of the renal arteries in pregnant women with chronic kidney disease (CKD) of various stages. An overview of data on the arterial renal bed and a technique for obtaining ultrasound imaging and Dopplerographic measurement of the interlobar arteries of the kidneys are presented, since it is most informative to evaluate the peak systolic velocity (PSV) in the arteries of the renal parenchyma (namely, in the interlobar arteries) for the diagnosis of renal dysfunction already at the initial stages of CKD. The diagnostic significance of the Dopplerographic parameter of peak systolic velocity (PSV) of the interlobar arteries for determining the presence of CKD and chronic renal failure (CRF) in pregnant women by trimester is highlighted. Dopplerography with assessment of the PSV of the interlobar arteries of the kidneys can be used as a non-invasive, affordable, reproducible and inexpensive screening method for CKD in the gestational period.

The aim of the study was to analyze the catamnesis of patients who underwent surgical treatment of placenta accreta in specialized perinatal centers in the Russian Federation. Materials and methods. A retrospective multicenter study, analysis of clinical and anamnestic data, gynecological and obstetric catamnesis of 2.652 patients who underwent surgical treatment for placenta accreta in 2014—2024 in 31 regions of the Russian Federation, as well as V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation, V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia and hospitals of the Mother and Child Group of Companies. Results. Among the total cohort of 2652 patients, 229 (8.6%) patients underwent hysterectomy during surgical treatment of placenta accreta, 2423 (91.4%) patients underwent organ-preserving surgery, of which 609 (23%) underwent surgical sterilization. Hysterectomy compared with metroplasty was accompanied by a significantly greater blood loss of 2403 (1974—2850) versus 1693 (1105—23 75) ml (p<0.001), a higher incidence of intraoperative complications such as massive blood loss of more than 2500 ml (30.56% (n=70) versus 6.93%, (n=168), (p<0.001) and bladder resection (31.88% (n=73) vs. 2.23% (n=54), (p<0.001). In 2018 (83.28%) patients with organ-preserving surgery, the regular menstrual cycle was restored 4 (1—18) months after the operation. Menstrual cycle disorders and/or a symptomatic niche of the postoperative scar were noted in 55 (2.27%) cases. Clinical and laboratory manifestations of premature menopause were not observed in any case. Among 229 patients who underwent hysterectomy, 17 (7.42%) cases showed symptoms of premature menopause. The frequency of urinary problems did not differ significantly between the groups, amounting to 116 (4.78%) versus 15 (6.55%) cases (p=0.242), in metroplasty and hysterectomy, respectively. According to the PISQ questionnaire, sexual satisfaction was statistically higher in the group with organ-preserving surgery — 5 points, compared with organ-bearing surgery — 3 points (p=0.031). When analyzing the quality of life and health based on the Short Form 6 Dimensions SF-6D questionnaire in women with metroplasty, the median score was significantly higher than in patients with a removed uterus: 4 (3—5) versus 3 (1—4) of the maximum 5, respectively (p=0.031). Of the 1.814 patients with preserved reproductive function, subsequent pregnancies were observed in 7.88% (n=143), 88.11% (n=126) of which ended in delivery. The frequency of timely delivery was significantly higher than that of preterm delivery: 83.33% (n=105) cases versus 16.67% (n=21) (p<0.001). Among all deliveries, the median volume of intraoperative blood loss was 880 ml. Placenta accreta was diagnosed in 7.1% (n=9) of the cases, in one of which (0.79%, 1/126) it was complicated by massive blood loss, which caused a hysterectomy. Postpartum bleeding occurred in 3 (2.38%) patients. Neonatal outcomes did not differ from the population data. An analysis of blood flow reduction methods in the previous surgical treatment of placenta accreta demonstrated a significant correlation between the use of complex compression hemostasis with the possibility of organ-preserving surgery and the uncomplicated course of subsequent pregnancy. Conclusion. The results of the second stage of a multicenter nationwide study demonstrated that organ-preserving surgery for placenta accreta is associated with fewer intra– and postoperative complications, improved quality of life in patients and the possibility of further realization of their reproductive function.

This review of published works summarizes current data on the prevalence, etiology, pathogenesis, diagnosis, and treatment of premature ovarian failure (POF). Projective. To present a systematic analysis of published works on the problem of premature ovarian failure, diagnostic capabilities, and optimal treatment methods for this pathology. The analysis includes data from international and domestic studies published in the Scopus, Elibrary, Pubmed, Google Scholar, Web of Science, Paperity, DOAJ, re-pository.tma.uz, archivog.com, and Media Sphere databases up to 2024. The article primarily presents data from scientific papers published over the past 10 years. The clinical presentation is characterized by oligo- or amenorrhea and genitourinary menopausal syndrome. Patients with POF require a specific approach and treatment depending on their reproductive plans. The primary treatment for patients with POF is hormone replacement therapy. Early detection of latent and clinically manifest forms of POF using pelvic ultrasound, assessment of hormonal status, and clinical symptoms helps practitioners develop a management algorithm for patients with this condition to prevent age-related diseases.

Modern medical practice has seen an increase in the number of cases of malignant neoplasms diagnosed in women during pregnancy. Despite advances in research, many questions remain regarding the potential adverse effects of maternal cancer on the health of offspring. This literature review analyzes researchers’ hypotheses regarding the mechanisms by which maternal cancer influences fetal development, presents data on the incidence of congenital anomalies, and discusses the specifics of prenatal diagnosis in this patient population. According to current data, there is an association between maternal cancer and the risk of fetal congenital malformations, particularly in the cardiovascular, nervous, musculoskeletal, and respiratory systems. The highest risk of congenital anomalies is observed in leukemia and breast cancer. However, most studies do not demonstrate statistically significant results, indicating the need for additional multicenter and prospective studies. The importance of strengthening pregnancy monitoring, improving prenatal diagnostic methods, and implementing a personalized multidisciplinary approach to monitoring pregnant women with cancer is emphasized, which increases the chances of favorable outcomes for both mother and fetus.

The frequency of detection of malignant neoplasms in pregnant patients has been steadily increasing in recent years. The management of patients with this pathology raises many questions, including the potential for negative effects on the fetus of both the oncological process itself and diagnostic technologies and treatment protocols prescribed to the mother. The combination of cancer and pregnancy is a complex problem that requires an interdisciplinary approach involving doctors of various specialties, from oncologists, surgeons, chemotherapists to obstetricians and gynecologists, geneticists, and psychotherapists. The paper presents a unique clinical case with pathological conditions diagnosed during pregnancy in the mother and fetus: breast cancer in the pregnant woman, craniosynostosis in combination with heterozygous variants in the CDC42BPB and RPS6KA3 genes in the fetus. Due to the high level of antenatal ultrasound diagnostics at the third-level institution and successful inter-clinical cooperation, it was possible to develop optimal tactics for managing pregnancy and childbirth, as well as provide timely specialized treatment for the mother and newborn. The article draws attention to the urgent need to improve the quality of outpatient examination and screening stages of prenatal fetal examination, as well as the development of an individualized multidisciplinary approach to the management of cancer patients diagnosed during pregnancy, aimed at maximizing the effectiveness of treatment, increasing the duration and quality of life for both patients.

Placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with increasing cesarean delivery rates worldwide. Existing classifica

The perimenopausal period and menopause are often accompanied by symptoms of depression, since a decrease in estrogen levels causes the decline of reproductive function, emotional disorders, vasomotor symptoms, and genitourinary menopausal syndrome. Since the occurrence of disorders in the psycho-emotional sphere is due to the direct genomic effect of hypoestrogenism, hormone replacement therapy remains the most effective treatment method for vasomotor manifestations. The appointment of antidepressants, neuroleptics, antiepileptic drugs, and anxiolytics allows for a sustained effect in the emotional sphere, improving both the general condition and mental status of women during menopausal transition and menopause.

Objective. Evaluation of the effectiveness of the effect of various hormone therapy regimens on the severity of clinical symptoms in patients with premature ovarian insufficiency. Materials and methods. A prospective opened scientific study was conducted involving 56 patients with premature ovarian insufficiency. The general cohort was divided into two groups depending on the reproductive plans of the patients. Group 1 included 31 patients who received hormone replacement therapy aimed to preserve ovarian function with the possible subsequent onset of pregnancy. The 2nd group included 25 patients who had no reproductive plans and were prescribed a combined oral contraceptive. All patients underwent a thorough clinical and laboratory examination, paying attention to the collection of family anamnesis, a clinical assessment of the severity of menopausal syndrome on the Green scale, and the results of hormonal studies. Ultrasound examination of the pelvic organs was performed 2, 6, and 12 months after the start of hormonal therapy. Mathematical methods included statistical analysis carried out using Microsoft Office 2007 and Excel 2007 licensed application programs. Results. After 12 months of hormone therapy, both groups showed a statistically significant decrease in the severity of such symptoms of estrogen deficiency as sweating and genitourinary menopausal syndrome. In group 2 patients, a statistically significant decrease in the frequency of episodes of insomnia and hot flashes was also achieved. The severity of the remaining symptoms of estrogen deficiency decreased by 2 times when calculated on the Green scale and amounted to 10—11 points, which was regarded as a mild degree of estrogen deficiency. An analysis of the condition of patients in both groups showed that the use of both hormone replacement therapy and a combined oral contraceptive in women with premature ovarian insufficiency helps preserve their physical and mental health and prevent complications associated with estrogen deficiency. Conclusion. Patients with premature ovarian insufficiency need a special approach and therapy depending on their reproductive plans. Early detection of latent and clinically pronounced forms of premature ovarian insufficiency helps the doctor to develop an algorithm for managing patients with this pathology in order to prevent age-related diseases. Patients of both groups showed high compliance and clinical effectiveness of the therapy, which contributes to improving the quality of life.