Gynecology

Human papillomavirus (HPV) is the leading etiological factor in the development of intraepithelial neoplasia’s and malignant neoplasms of the anogenital region. A distinctive clinical feature of the HPV-associated process is its propensity to form multifocal lesions, in which neoplasia’s of different anatomical sites – the cervix, vagina, vulva, and anal canal (CIN, VAIN, VIN, and AIN) – are detected either synchronously or metachronously during follow-up. Despite the high prevalence of this phenomenon, its pathogenetic basis remains a subject of debate. Existing interpretations predominantly regard such lesions as a set of independent local processes. In recent years, accumulating evidence has shown that HPV is capable of establishing persistent populations of infected cells that retain proliferative potential over extended periods. These changes create conditions for long-term viral persistence in epithelial tissues and maintenance of subclinical infection. In this context, multifocal HPV-associated lesions can be considered a manifestation of a single pathological process driven by prolonged viral persistence in the anogenital epithelium. Analysis of these mechanisms is of considerable interest for understanding the patterns of HPV infection spread, the development of multifocal neoplasia’s, and their clinical course. Multifocal HPV-associated lesions of the anogenital region reflect the complex, multilevel nature of the underlying pathogenesis and create significant challenges for their timely detection. In this setting, optimization of patient management requires a comprehensive diagnostic approach, including advanced visualization techniques, morphological and molecular-biological verification, as well as the development of personalized risk stratification strategies. These strategies aim to prevent disease progression and reduce the recurrence rate of precancerous lesions in the anogenital area.

Human papillomavirus (HPV) represents the most prevalent sexually transmitted infection worldwide. According to data from the World Health Organization, over 290 million women globally are infected, with prevalence rates among sexually active individuals ranging from 50% to 80%. The high prevalence of oncogenic HPV significantly contributes to the development of cervical, vulvar, vaginal, and anal cancers. This underscores the clinical relevance of the infection and emphasizes the need to identify the earliest and most informative diagnostic methods. The minimally invasive liquid biopsy technique, which detects viral and tumor nucleic acids in biological fluids such as blood, urine, and saliva, offers new avenues for diagnosing and predicting precancerous and malignant diseases of the anogenital region. In contrast to traditional biopsy methods that require surgical intervention to obtain tissue samples, liquid biopsy is a safe, painless alternative that allows repeated testing at necessary intervals. To date, several biomarkers with promising diagnostic potential have been identified in gynecological oncology. Among these, microRNAs (miRNAs) – short non-coding RNAs that regulate post-transcription gene expression – have emerged as particularly noteworthy. In the context of HPV-associated carcinogenesis, the viral infection induces alterations in miRNA expression within infected epithelial cells, which subsequently leads to distinctive changes in their profiles in blood, urine, and saliva. These characteristics position miRNAs as potential candidates for the development of non-invasive diagnostic panels, warranting further investigation in this field.

Perinatal depressive disorders are pathogenetically heterogeneous clinical conditions characterized by systemic metabolic dysregulation and represent a substantial burden on maternal and child healthcare systems; however, the accuracy and scope of traditional screening instruments remain limited. An analysis was conducted of the achievements in the field of omics-based diagnostics of perinatal depression (PND), and an analytical review of studies published between 2016 and 2026 was conducted, with targeted search for potential molecular patterns relevant to screening, diagnosis, and prediction of PND clinical outcomes. In several studies, metabolomic profiling revealed statistically significant differences in blood metabolite profiles of patients with PND, including differential levels of amino acids, gluconeogenesis substrates, neurotransmitter metabolism intermediates, and purine metabolism products (threonine, serine, ornithine/arginine, valine, leucine, isoleucine, lysine and aminomalonic acid, threonate, sorbitol, glutamate, uric acid, glyoxylate, gluconate, glycerate and erythronate, glutathione disulfide, adenylsuccinate and adenosine triphosphate). Over the past decade, scientific interest has appropriately shifted toward objectifying the diagnostic process through integration of metabolome research as a high-throughput method that allows characterizing changes in the molecular profile and improving the accuracy of screening, diagnosis, and prediction of PND.

The presented article describes the key aspects of uterine fibroids (UF) and endometriosis, the most common benign hyperplastic processes in the female reproductive system, pathogenesis from the perspective of current research trends in this medical theme. The review of literature published over the past 10 years aims to update and systematize information on risk factors and molecular mechanisms of these diseases. The article covers the influence of genetics, epigenetics, hormonal stimulation, lifestyle, parity, microbiome, immune system, and ferroptosis on their development. Hormonal stimulation is one of the key links in the pathogenesis of UF and endometriosis. This is why the ability to medically suppress hormonal effects on tissues has long been the main conservative treatment for these benign gynecological hyperplasias worldwide. Hormonal modulation is the mechanism of action of a new combination drug containing the gonadotrope-releasing hormone (GnRH) antagonist relugolix 40 mg, as well as estradiol 1 mg and norethisterone acetate 0.5 mg. Long-term and high-quality suppression of sex steroid secretion due to the blocking of the hypothalamic-pituitary-ovarian axis without pronounced side effects caused by hypoestrogenia allows us to consider it as a promising drug in the treatment of UF, endometriosis, as well as their combination. The new combined oral GnRH antagonist is capable of relieving two main symptoms that affect the life quality of patients suffering from these conditions: abnormal uterine bleeding associated with leiomyoma and chronic pelvic pain – a common companion of endometriosis. To date, published studies have demonstrated the high clinical efficacy and favorable safety profile of using a prolonged regimen of the drug for up to 104 weeks (2 years). The effects of the drug on the size of uterine fibroids and endometrioid heterotopias during long-term use are still under investigation. The practice-oriented part of the material describes the patient cohorts that are most promising in terms of the use of a new oral GnRH antagonist. This information may be useful to obstetricians and gynecologists when choosing the most optimal treatment strategy for each individual patient.

Background. Excisional treatments for cervical pathology, such as loop excision of the transformation zone (LLETZ) and conization, are widely used in women of reproductive age. However, they are associated with an increased risk of cervical insufficiency and preterm birth in subsequent pregnancies: the incidence of preterm birth in this category of patients reaches 8–12%, which is 2–4 times higher than the general population rate. The pathogenesis of cervical insufficiency after excision is due to decreased mechanical strength of the cervix due to loss of stromal volume, disruption of collagen architecture, and changes in the antimicrobial properties of cervical mucus. Despite this, most patients with a history of excisional treatment undergo measurement of cervical length only as part of the standard second screening at 19–21 weeks, which does not allow for the timely detection of progressive cervical shortening and prevention of miscarriage. The lack of a unified algorithm for early monitoring of the cervical condition in this group determines the relevance of assessing the effectiveness of a differentiated approach with the beginning of transvaginal cervicometry from 16 weeks of pregnancy.

Aim. To evaluate the effectiveness of early cervical length screening in pregnant women with a history of excisional cervical treatment for the prevention of cervical insufficiency and preterm birth.

Materials and methods. A prospective study included 50 pregnant women: 30 after LLETZ and 20 after conization. Transvaginal cervical length measurement was performed from 16 weeks every 7–10 days until 24 weeks and compared with a retrospective cohort where screening began at 19–21 weeks.

Results. The rate of pregnancy loss was 6% versus 12% in the standard observation group. No losses before 28 weeks were recorded. An interval of less than 12 months between excision and conception significantly increased the risk of pregnancy loss.

Conclusion. Women with prior excisional cervical treatment should be considered a high-risk group for cervical insufficiency. Cervical length screening should begin at 16 weeks of gestation with 7–10-day intervals. If cervical length <20 mm, cerclage should be considered even without previous pregnancy loss.

Background. The reproductive health of adolescents serves as a crucial indicator of the reproductive potential within a population. The menstrual cycle self-monitoring skills and the hygienic practices acquired during puberty significantly influence women's health in later life.

Aim. To analyze the characteristics of menstrual health and hygiene among adolescent girls, with a focus on assessing the risks associated with reproductive disorders.

Materials and methods. An anonymous, cross-sectional online questionnaire was distributed to 3,668 girls aged 13 to 17 across four regions in the Far Eastern Federal District. Utilizing cluster analysis, the participants were categorized into low (n=2,104) and high (n=1,564) reproductive risk groups. Statistical analyses were performed using IBM SPSS Statistics 25.0.

Results. The age of participants in both groups was statistically comparable (p=0.87). Within the low-risk group, there was a significantly higher prevalence of city residents (64.2% vs. 49.8%; p<0.001), individuals with regular menstrual cycles (94.3% vs. 41.2%; p<0.001), those maintaining a menstrual calendar (87.4% vs. 52.3%, χ²=312.5; p<0.001), and adequate frequency of hygiene practices (95.8% vs. 81.5%; p<0.001). Additionally, the age of menarche was notably higher in this group, recorded at 12.0 years (interquartile range: 11.0; 13.0) vs. 11.0 years (interquartile range: 10.0; 12.0) in the high-risk group (p<0.001). Pain intensity was lower in the low-risk group, with a score of 2.0 (interquartile range: 1.0; 3.0), compared with 8.0 (interquartile range: 7.0; 9.0) in the high-risk group (p<0.001). Key predictors for high risk included dysmenorrhea (odds ratio [OR] 4.2, 95% confidence interval [CI] 3.5–5.1; p=0.001), irregular menstrual cycles (OR 3.8, 95% CI 3.2–4.6; p=0.002), lack of menstrual cycle monitoring (OR 2.1, 95% CI 1.8–2.5; p=0.015), non-compliance with hygiene practices (OR 1.9, 95% CI 1.6–2.3; p=0.032), and residing in rural areas (OR 1.4, 95% CI 1.1–1.7; p=0.041). The regression model created, which incorporates these predictors, demonstrates high discriminatory ability, with an area under the curve of 0.86, sensitivity of 78.4%, and specificity of 81.2%.

Conclusion. The assessment of demographic potential indicates that 42.6% of adolescent girls are at a high risk for reproductive disorders. Effective strategies to address this issue may include educational initiatives and awareness campaigns, particularly through online modules that increase access to reproductive education for young women in rural areas. The developed regression model holds potential as a valuable screening tool to enhance the accuracy of individual reproductive prognoses.

Background. Endometriosis is a chronic, estrogen-dependent inflammatory disease characterized by the presence of endometrial tissue outside the uterine cavity. Despite advances in understanding its pathogenesis, optimal strategies for effective and safe therapy, particularly for deep infiltrative forms, remain undetermined. Local inflammatory responses and disruptions in immune homeostasis are central to endometriosis pathogenesis, supporting the inclusion of anti-inflammatory and immunomodulatory agents in treatment regimens.

Aim. To evaluate the efficacy of combination therapy with dienogest and a protein-peptide complex in women diagnosed with deep endometriosis and chronic pelvic pain syndrome.

Materials and methods. This prospective comparative study included 60 reproductive-age women with deep pelvic endometriosis, confirmed by ultrasound, and chronic pelvic pain syndrome. The main group (n=30) received dienogest 2 mg daily for 6 months, combined with a protein-peptide complex (Superlymph, containing natural antimicrobial peptides and cytokines) administered as one rectal suppository daily for 80 days. The comparison group (n=30) received Dienogest 2 mg daily as monotherapy. Pain dynamics were assessed using the Visual Analog Scale, quality of life was measured with the Medical Outcomes Study-Short Form (MOS SF-36) questionnaire, and the size and volume of endometriotic infiltrates were evaluated according to the ENZIAN(u) classification before and after 6 months of treatment.

Results. The main group demonstrated a significantly greater reduction in pain. After 6 months of therapy, pain intensity on the Visual Analog Scale decreased by 68% (from 8.1±1.3 to 2.6±0.9 points), compared with a 55% reduction in the comparison group (p<0.05). Quality of life, as measured by the Bodily Pain scale, improved by 2.05 times in the main group and by 1.89 times in the comparison group (p<0.05). Regression of endometriotic infiltrates, determined by ultrasound based on the sum of linear dimensions, ranged from 18–42% in the main group versus 12–36% in the comparison group (p<0.05). When recalculated as volume over the 6-month treatment period, the average regression in the main group was 57.1%, compared with 42.9% in the comparison group (p<0.01), indicating a more substantial reduction in infiltrates with combination therapy.

Conclusion. Adding a protein-peptide complex (Superlymph) to dienogest therapy in patients with deep endometriosis produces a more pronounced and sustained clinical effect, including significant regression of pain, improved quality of life, and greater reduction of endometriotic infiltrates. Combination therapy has a favorable safety profile and may be a promising strategy for managing this patient population.

Spontaneous rupture of the kidney during pregnancy is an uncommon but potentially life-threatening condition that poses significant risks to both the mother and the child. The primary causes of kidney rupture during this period include the rupture of a kidney tumor (such as angiomyolipomas), gestational hydronephrosis, hypertensive disorders, thrombotic microangiopathies, trauma, and kidney infarction. One of the challenges in managing this condition is that the kidney is often not initially suspected as a source of bleeding, leading to a delay in the diagnosis of kidney rupture. This report analyzes a clinical case involving the successful intraoperative verification of renal angiomyolipoma during a cesarean section in a full-term pregnancy. A 32-year-old multiparous patient presented with acute pain in the right hypochondrium and lower back, along with hypotension and tachycardia, in the context of regular labor activity. This clinical presentation was initially misinterpreted as a sign of premature placental abruption. Due to a deterioration in fetal condition, an emergency cesarean section was performed, revealing a retroperitoneal hematoma of unknown origin. Following transfer to a specialized hospital, spiral computed tomography confirmed the diagnosis of a ruptured right kidney, which was verified during surgery. Nephrectomy was subsequently performed, and histological examination revealed the underlying cause to be renal angiomyolipoma. The postoperative recovery was uneventful, and the patient was discharged in satisfactory condition on Day 15 post-surgery. Pregnancy has the potential to prompt the growth of tumors such as angiomyolipoma, thereby increasing the risk of spontaneous rupture, particularly with the onset of labor. While this is a rare complication, it requires an interdisciplinary approach for effective diagnosis and treatment.