Gynecology

Background. Dysbiotic conditions among pregnant women may lead to the translocation of opportunistic microorganisms into breast milk through the enteromammary pathway, thereby increasing the risk of lactostasis, mastitis, and neonatal gastrointestinal disorders. Administering probiotics during this critical period may be an effective preventive strategy.

Aim. To evaluate the impact of oral probiotics on the microbiota of breast milk, the incidence of lactation-related complications in new mothers, and the health status of newborns during the first six weeks of life.

Materials and methods. A prospective randomized study was conducted involving 80 pregnant women. Participants were divided into three groups: a control group (physiological vaginal pH 3.8–4.5, n = 25); subgroup 2A (pH > 4.5, received probiotics, n = 30); and subgroup 2B (pH > 4.5, received no probiotics, n = 25). A breast milk culture was performed during the early postpartum period, and the incidence of lactostasis, mastitis, and neonatal gastrointestinal symptoms and infectious complications was assessed.

Results. Pathogens in breast milk were identified in over half of the cases in the subgroup without probiotics, with Staphylococcus aureus being predominant. Other microorganisms, such as Streptococcus agalactiae, Escherichia coli, and Klebsiella pneumoniae, as well as microbial associations, were also isolated. In contrast, the frequency of pathogen detection was significantly lower in the probiotic-treated group, with no S. agalactiae or its associated forms isolated. Lactostasis and lactation mastitis, including purulent forms, were reported infrequently in both the probiotic and control groups. In the subgroup without probiotics, these complications occurred significantly more frequently. Moreover, newborns whose mothers received probiotics experienced fewer episodes of infantile colic and regurgitation, whereas severe enterocolitis was reported exclusively in infants from the group without probiotic support.

Conclusion. Administering oral probiotics to pregnant women with baseline vaginal pH > 4.5 aims to restore the intestinal microbiota. This improvement in intestinal microbiocenosis is associated with an indirect reduction in the frequency of pathogen detection in breast milk, a decreased occurrence of lactostasis and mastitis (including purulent forms) among new mothers, as well as a significant reduction in gastrointestinal symptoms (regurgitation and colic) in newborns, compared to those without probiotic intervention.

Background. A comprehensive understanding of the relationship between uterine scars and the blood flow in adjacent myometrial tissue is crucial for the early identification of risk groups, which can significantly reduce the incidence of complications, facilitate differential diagnosis, and inform effective treatment strategies for patients with uterine scar defects (USD).

Aim. To study the histoarchitectural features, area and percentage of collagen fibers in excised scar tissue from the uterus, contingent upon the blood flow status in the adjacent myometrium.

Materials and methods. Laparoscopic metroplasty was performed on patients diagnosed with USD, categorized into two groups based on blood flow assessment via functional magnetic resonance imaging (fMRI): preserved blood flow (n = 6) and impaired blood flow (n = 6). A histochemical examination was performed on samples of excised fibrous tissue from the scars, focusing on morphometric analysis, area, and the percentage of collagen fibers contingent upon the blood flow characteristics in the adjacent myometrium.

Results. The mean age of the participants was 35.17 ± 3.35 years. The predominant complaints included postmenstrual spotting in 8 of 12 patients (66.7%), heavy menstruation in 3 patients (25%), pain in 2 patients (16.7%), and infertility in 3 patients (25%). According to fMRI, the average scar thickness was 2.16 ± 0.74 mm. Scar samples with impaired blood flow demonstrated a statistically significant reduction in both the area and percentage of collagen fibers by 2.2 times (p = 0.03) and 1.9 times (p = 0.01), respectively, when compared to samples without circulatory disorders.

Conclusions. The state of blood flow in the adjacent myometrium significantly influences the development of the connective tissue component in scar tissue. Assessment of perfusion blood flow in the adjacent myometrium using fMRI could serve as an indicator of the morphological integrity of the uterine scar following cesarean section. Consequently, fMRI may serve as an additional diagnostic tool and assist in formulating management strategies for patients with USD.

Background. The choice of combined hormonal contraception in overweight women of reproductive age requires an assessment of not only contraceptive efficacy but also metabolic safety, as abdominal obesity, atherogenic dyslipidemia, insulin resistance, and blood pressure are key modifiable cardiovascular risk factors. A monophasic combined oral contraceptive (COC) containing estetrol 15 mg and drospirenone 3 mg is considered a drug with a potentially more favorable metabolic profile compared to COCs containing synthetic ethinyl estradiol. However, data on the effect of Esteretta (estetrol 15 mg + drospirenone 3 mg) on metabolic parameters in overweight women in real-world clinical settings remain limited.

Aim. To evaluate the dynamics of metabolic parameters and calculated indices of cardiovascular risk in women with normal and overweight body weight during the use of COC containing 15 mg estetrol and 3 mg drospirenone.

Materials and methods. An open observational study was conducted at Clinical and Diagnostic Outpatient Clinic of Volgograd Regional Clinical Perinatal Center No. 2 in Volgograd. The study included 168 women of reproductive age seeking contraception. All patients were prescribed the COC Esteretta (estetrol 15 mg + drospirenone 3 mg). The study group included 82 overweight women (BMI 25.0–29.9 kg/m²), and the comparison group included 86 patients with normal body weight (BMI 18.5–24.9 kg/m²). The examination was conducted at baseline and after 3 and 6 months. Anthropometric parameters, blood pressure, lipid profile, fasting glucose, visceral adiposity index, triglyceride-to-high-density lipoprotein cholesterol ratio, plasma atherogenic index, triglyceride-glucose index, lipid accumulation index, and the presence of metabolic syndrome (MS) according to the 2026 RKO/RNMOT criteria were analyzed.

Results. After 6 months, use of the Esteretta COC (estetrol 15 mg + drospirenone 3 mg) was associated with clinically insignificant changes in metabolic and calculated cardiometabolic parameters in both groups. The proportion of patients with age-related visceral adiposity index and triglyceride-to-high-density lipoprotein cholesterol ratio > 1.196 did not increase and remained 0% at all visits in both groups. Using the 2026 RCO/RNMOT Consensus criteria, the estimated compliance with MS criteria in the overweight group was found in 13/82 (15.9%) patients at baseline and in 16/82 (19.5%) after 6 months, the change was not statistically significant (p = 0.250). In the normal weight group, the estimated compliance with MS criteria was not found in any patient at any visit.

Conclusion. The use of the COC Esteretta (estetrol 15 mg + drospirenone 3 mg) for 6 months in overweight, non-obese women is not associated with a clinically significant deterioration in the cardiometabolic profile. However, regular (at least once every 6 months) monitoring of metabolic parameters and active lifestyle modification remain necessary in overweight women receiving hormonal contraception.

Background. Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are common conditions that significantly impact the quality of life for women of reproductive age. Although standard treatments for BV and VVC are effective at alleviating acute symptoms, they often fail to restore the vaginal microbiota in the long term.

Aim. To evaluate the efficacy and safety of oral multiprobiotics as part of the comprehensive therapy for BV and VVC.

Materials and methods. A prospective, randomized, double-blind, placebo-controlled, parallel study was conducted involving 180 patients of reproductive age. The cohort comprised 90 individuals with confirmed BV and 90 with VVC. Patients were randomized into four groups: BV with probiotic (n = 50), BV with placebo (n = 40), VVC with probiotic (n = 50), and VVC with placebo (n = 40). The investigational agent was a multiprobiotic formulation containing Lactobacillus rhamnosus, L. plantarum, L. helveticus, L. gasseri, and L. crispatus. The treatment duration was one month. Parameters assessed included changes in clinical symptoms (using a 10-point scale), vaginal pH, vaginal microflora composition (analyzed via real-time polymerase chain reaction using Femoflor-16), and patient satisfaction with treatment outcomes.

Results. The addition of the multiprobiotic from the initiation of standard therapy significantly contributed to the restoration of normal vaginal microbiota composition, evidenced by a substantial increase in the proportion of Lactobacillus spp. (p < 0.001), normalization of vaginal pH and more pronounced relief of clinical symptoms compared to placebo (p < 0.001), and increased patient satisfaction with the treatment outcomes (p < 0.05). Specifically, the increase in Lactobacillus spp. in the BV + probiotic group was 33.3% vs. 14.4% in the placebo group (p < 0.001), while in the VVC + probiotic group, it was 19.8% vs. 6.7% (p < 0.001). According to Femoflor-16 data, the absolute increase in Lactobacillus spp. concentration in the BV + probiotic group was 1.8 times greater (+3.48lg vs. +1.94lg), and the reduction of BV-associated anaerobes was 1.8–2.3 times more significant than in the placebo group (all p < 0.001). For the VVC + probiotic group, the elimination of Candida spp. was 1.4 times more pronounced (-3.86lg vs. -2.72lg; p < 0.001), and the increase in lactobacilli was six times greater. Additionally, significant reductions in Staphylococcus spp., Streptococcus spp., and Enterobacteriaceae were documented in the probiotic group, with no similar changes observed in the placebo group. Patients diagnosed with VVC exhibited a significant decrease in pH levels by 0.46 units (p < 0.001). Following therapy, the probiotic groups presented statistically significant reductions in clinical symptom severity when compared with the placebo groups (p < 0.001). In BV patients, the intensity of abnormal discharge averaged 1.2 ± 0.8 points vs. 2.1 ± 1.2 points, and the unpleasant odor intensity averaged 0.8 ± 0.6 points vs. 1.5 ± 0.9 points. In VVC patients, the severity of itching and burning was recorded at 0.9 ± 0.7 points vs. 1.8 ± 1.1 points. Treatment satisfaction was notably higher in the probiotic groups: 88% vs. 70% for BV (p = 0.034) and 86% vs. 65% for VVC (p = 0.019).

Conclusions. The findings of this study support the inclusion of oral multiprobiotics that contain combinations of L. rhamnosus, L. plantarum, L. helveticus, L. gasseri, and L. crispatus in comprehensive treatment regimens from the first day of therapy for BV and VVC, as this approach enhances treatment efficacy and may reduce the risk of relapse.

Endometriosis is a chronic, estrogen-dependent condition characterized by a significant fibrosing component, which substantially impacts the pain, reproductive function, and overall quality of life for affected individuals. Given the limitations of current therapeutic options and the high recurrence rates, there is a justified need to explore pathogenetic strategies to modify fibrosis and chronic inflammation. This review evaluates the latest findings on the role of fibrosis in the pathogenesis of endometriosis, along with the nature of the inflammatory and immune responses and their associations with pain-related, reproductive, and adhesive complications accompanying the disorder. In particular, the focus is on bovhyaluronidase azoximer as an antifibrotic, anti-inflammatory, and immunomodulatory agent used in the combined treatment regimen for endometriosis, particularly during the postoperative phase. The findings from preclinical investigations, along with 11 clinical trials involving over 1,200 patients, demonstrate reductions in pain severity, improvements in reproductive outcomes, decreased frequency and severity of adhesion formation, and a favorable safety profile associated with bovhyaluronidase azoximer administration. In light of the collective data, this review discusses the potential to incorporate antifibrotic therapy into standard care protocols for patients with endometriosis, as well as the directions for future clinical research, including optimizing dosing protocols, establishing the appropriate duration of therapy, and assessing long-term outcomes.

Preserving the reproductive potential of women with endometrial diseases is an urgent task of modern reproductive medicine due to the increase in their prevalence and the fact that many women postpone pregnancy to a later age, which is especially common in developed countries. The article reviews the literature published in recent years on modern approaches to preserving fertility in patients with endometrial hyperplasia and low-grade endometrial adenocarcinoma, including organ-preserving therapies and methods to realize reproductive potential after treatment, as well as assessment of the endometrium after treatment and the use of assisted reproductive technologies. Organ-preserving therapy for endometrial hyperplasia aims to optimize oncological and reproductive outcomes while minimizing side effects. Hormone therapy used in these disorders contributes to a decrease in the receptive properties of the endometrium and reduces the probability of pregnancy. Therefore, despite attempts to optimize treatment, after hormonal therapy, patients with endometrial hyperplasia without atypia, as well as with atypical endometrial hyperplasia and low-grade endometrial adenocarcinoma of reproductive age, face problems in achieving pregnancy. The lack of standardized approaches to assessing the recovery of implantation properties of the endometrium makes it difficult to develop pregnancy planning programs after treatment for such patients of fertile age.