Olga Vladimirovna Kapitanova

A uterine scar is a connective tissue area in the myometrium that results from surgical intervention, injury, or inflammation. It is characterized by the replacement of smooth muscle fibers with fibrous tissue, as well as abnormalities in myometrial vascularization, innervation, and architecture. These abnormal changes impair the function of the uterus and increase the risk of obstetric and gynecological complications. The rising global cesarean section rates continue to be a major concern. In Russia, they were 30.1% in 2022, which is comparable to North America (32.3%), lower than in Latin America (40.5%) and Turkey (57.2%), but considerably higher than the WHO-recommended threshold of 10%–15%. As cesarean section rates increase, so does the number of patients with postoperative uterine scars and specific complications. These complications include isthmocele with myometrial thinning at the scar site (residual myometrial thickness at the scar site 3–2.5 mm on ultrasound). Preconception monitoring is used to minimize risks, with surgical treatment (metroplasty) as indicated. Metroplasty, however, carries the risk of complications such as genital fistulas, which are uncommon but clinically significant. This article presents a clinical case of a uterocervicovaginal fistula after vaginal metroplasty. According to the medical history, a patient with uterine isthmocele in the lower segment had a spontaneous singleton pregnancy after surgical treatment. The pregnancy ended in abortion with expulsion of the gestational sac through the fistulous opening. The patient underwent repeat surgery at the Department of Operative Gynecology and Gynecologic Oncology with Day Hospital, V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology. The procedure aimed to restore the anatomic integrity of the reproductive organs and to provide preconception care for a future pregnancy. This is the first published report of this complication, highlighting its clinical and scientific significance.

Pelvic organ prolapse remains one of the most common conditions in modern gynecology. Trauma to the soft birth canal during spontaneous childbirth is the main cause of this pathology. Early diagnosis of hidden pelvic floor injuries is necessary for the selection of further patient management tactics both in the early and late postpartum periods, as well as during follow-up. Modern ultrasound diagnostic methods using 2D and 3D visualization allow for the most accurate identification of anatomical defects, and the use of not only transvaginal examination methods but also a transrectal approach allows modeling and more accurately determining the necessary treatment method and extent.

Uterine fibroids are a common pathological process affecting 30 to 80% of women of reproductive age. Uterine fibroids are often asymptomatic, but the appearance of complaints of menorrhagia, pelvic pain, symptoms of pelvic organ compression require surgical treatment. In women who want to preserve their fertility, myomectomy is an alternative to hysterectomy. Myomectomy, like any surgical intervention on the pelvic organs, can lead to the formation of an adhesion process, reaching up to 83-94% of cases during laparotomy interventions. Minimizing surgical trauma to the anterior abdominal wall during laparoscopic surgery facilitates early pa-tient mobilization. This reduces the time of postoperative rehabilitation and decreases the severity of the adhe-sion process in the surgical intervention area compared to open surgeries, which helps to reduce the incidence of postoperative complications. However, there is evidence that the frequency of rehospitalization after laparotomy and laparoscopic surgeries on the pelvic organs is comparable. To date, no definitive strategies, recommendations, or guidelines have been developed to prevent the development of pelvic adhesions after myomectomy.

Objective. Optimisation of pregravidal preparation of patients with various forms of hyperprolactinemia to increase reproductive potential. Material and methods. Prospective examination and treatment of 58 patients with different types of hyperprolactinemia were carried out. Depending on the type of hyperprolactinemia all patients were divided into 4 groups: patients with functional hyperprolactinemia, microadenoma and macroadenoma of pituitary gland and macroprolactinemia’s phenomenon. The examination of patients included a standard range of laboratory and instrumental investigations. Results. The peculiarities of menstrual cycle and reproductive function disorders, frequency of development of concomitant endocrine and somatic diseases in different forms of hyperprolactinemia were studied. As a result of complex pregravidal preparation of patients with hyperprolactinemia pregnancy occurred in 25 (86%) out of 29 women who planned it. At the same time, 11 (44%) patients became pregnant against the background of cabergoline treatment and 3—6 months after its cancellation, and 14 (56%) patients additionally underwent ovulation stimulation cycles. Conclusion. To restore the regulation of menstrual cycle and reproductive function in patients with hyperprolactinemia of different genesis it is reasonable to use dopamine agonists, gestagens, as well as estrogens and inducers of ovulation.

The paper presents a clinical case of diagnostics and treatment of a rare form of anomaly of the müllerian ducts development — an additional isolated cavity in the normally formed uterus (accessory and cavitated uterine mass) — acum, cavity communication with the endocervical cavity being a specific feature, which may indicate acum forms variability. This clinical case demonstrates a variety of anomalies of the müllerian ducts.

Аденосаркома матки — редкая бифазная опухоль с доброкачественным эпителиальным и злокачественным мезенхимальным компонентами, нередко представляющая трудности для морфологической диагностики. Описано 5 наблюдений аденосаркомы тела, шейки матки и культи влагалища у пациенток 46—76 лет. Представлены клинические данные, результаты ультразвукового исследования, морфологические данные, включая иммуногистохимическое исследование с антителами к CD10, рецепторам эстрогена и прогестерона, десмину, гладкомышечному актину, Ki-67. Крупные полиповидные образования тела и шейки матки эпителиально-мезенхимального строения у женщин пери- и постменопаузального возраста требуют исключения злокачественности мезенхимального компонента с прицельным поиском диагностических критериев — наличие камбиального слоя и митозов.