Gynecology

Background. Placental disorders underlie the development of a large number of pregnancy complications, such as growth retardation, fetal hypoxia and distress, preeclampsia, etc. Fetal hypoxia occurs in 10% of all pregnancies and is the cause of perinatal losses in 40% of cases. Uteroplacental hypoxia is associated with impaired placental formation in early pregnancy and its angiogenesis in later stages. Meanwhile, there are currently no technologies that can predict the development of placental disorders with a high degree of probability.

Aim. To evaluate the capabilities of neural network data analysis in predicting placental disorders.

Materials and methods. The prospective analysis of the features of the course of 99 pregnancies was conducted. Based on the results of the study, 2 groups were formed: the control group included 51 patients whose pregnancy was not complicated by the development of placental disorders, the main group included 48 patients whose pregnancy proceeded against the background of placental disorders.

Results. The technology for predicting placental disorders is implemented on the basis of the multilayer perceptron, the percentage of incorrect predictions during the training of which was 7.1%. The structure of the trained neural network included 8 input neurons, which were the parameters included in the Astraia protocol (height of the pregnant woman, coccygeal-parietal size, thickness of the collar space and heart rate of the fetus, pulsation index in the uterine arteries, the content of β-hCG and PAPP-A in the blood of the pregnant woman), as well as the volume of amniotic fluid.

Conclusion. An integrated approach based on neural network analysis of study parameters available for widespread clinical practice (Astraia protocol), as well as amniotic fluid volume, should be considered promising for predicting placental disorders due to its high information content (Se=0.87, Sp=0.98, ROC-AUC 0.921±0.04 [95% CI 0.843–0.998]; p<0.001). In our opinion, the use of this technology will be useful for identifying patients at risk in order to prevent the development of placental disorders and will reduce the incidence of adverse perinatal outcomes.

Background. Herpes virus infection poses a serious medical and social danger both at the country and global levels, inducing severe disorders leading to pregnancy complications, reproductive losses, and proliferative diseases.

Aim. To provide a clinical and immunological assessment; to analyze the state of lipid peroxidation factors and antioxidant protection in the complex therapy of recurrent genital herpes (GH) using Panavir®.

Materials and methods. The study was conducted from March 2024 to March 2025 at the Medical Institute of the RUDN University. The study included 125 females with GH relapses (5.0±2 episodes per year) aged 20–45 years. Molecular genetic studies for the presence of herpes simplex virus and the absence of other sexually transmitted infections were performed using polymerase chain reaction, and the content of isopropanol- and heptane-soluble primary, secondary, and final products of lipid peroxidation in plasma and lymphocytes, as well as serum superoxide dismutase and catalase activity were tested using the extraction-spectrophotometric method. The population and subpopulation composition of leukocytes was analyzed using flow cytometry. The serum levels of cytokines were measured using an enzyme-linked immunosorbent assay.

Results. In patients with GH relapse during complex therapy with Panavir® (0.04 mg/mL) intravenously 5 mL QD 2 doses, the levels of inflammatory cytokine mediators (interferon γ, interleukin-2, 8, 10, tumor necrosis factor α) were normalized, the number of receptors on the surface of lymphocytes was restored. Panavir® eliminates the effects of oxidative stress and restores the activity of antioxidant protection enzymes, which increases the effectiveness of treatment for recurrent herpes virus infection.

Conclusion. Panavir® (0.04 mg/mL) intravenously 5 mL QD 2 doses contributes to a favorable course and outcome of the disease, significantly reduces the number of relapses, and prolongs the inter-relapse period.

Background. Obesity is one of the diseases with the highest rate of spread reported. Adipose tissue plays a vital role in maintaining the physiological processes of the body, but there is an imbalance in metabolic disorders, which increases the risk of hyperplastic endometrial disorders.

Aim. To establish a correlation between body composition, namely the percentage of fat and its distribution, and the presence of endometrial hyperplasia (EH) in overweight or obese women of reproductive and premenopausal age. Bioimpedance analysis was used to assess body composition.

Materials and methods. A prospective analysis of 61 patients with EH and BMI>25 kg/m² was conducted.

Results. The risk of developing EH in patients with metabolic syndrome (MS) was 2.4 times higher compared to patients without it. Comparative lipid profiles in patients of the study groups differed significantly (p<0.05). The predominance of visceral obesity and the presence of MS in 80% of the participants in the main group were associated with EH.

Conclusion. The predominance of visceral obesity and the presence of MS were strongly associated with EH, pointing up the importance of assessing the BMI and waist circumference, as well as the inclusion of bioimpedance analysis of body composition in a set of diagnostic measures to predict the risk of developing hyperplastic endometrial changes in women with MS. A comprehensive analysis of blood chemistry parameters, in particular MS criteria, such as concentrations of triglycerides, high-density lipoproteins, low-density lipoproteins, and total cholesterol, is crucial. These indicators are also markers of an increased risk of hyperplastic processes in the endometrium.

Background. The primary method of treatment for severe pelvic organ prolapse (POP) is surgery. Despite the significant number of surgical interventions, the high incidence of complications and relapses makes it necessary to search for new methods of surgical treatment. Also, the search for drugs that improve tissue healing in the wound continues in order to reduce the incidence of postoperative complications and the number of relapses.

Aim. To evaluate the effect of Phlogenzym® on the postoperative period in women undergoing surgical treatment of POP.

Materials and methods. An open-label, single-center, prospective, comparative, randomized study enrolled 124 patients who underwent surgery for POP and divided them into two groups. In the main group (n=64), patients received traditional (infusion, antibacterial) therapy in combination with Phlogenzym® 3 tablets 3 times a day for 30 days in the pre- and postoperative period, while in the comparison group (n=60), only traditional therapy was used. The study included the assessment of medical history, daily recording of the patient’s condition by such clinical parameters as pain assessment using the Visual Analog Scale, body temperature, wound condition (edema, flushing), duration of hemorrhagic discharge, and clinical and biochemical blood tests at admission and discharge from the hospital.

Results. The age of patients in the main group was 63.0 (56.8; 69.0) years versus 61.0 (54.3; 68.0) years in the comparison group; p=0.24. Patients of the main group showed more improvements for every single studied indicator of the complete blood count, except for the erythrocyte sedimentation rate. A relatively stable erythrocyte sedimentation rate was observed, indicating that enzyme therapy positively affected the wound. Patients in the study groups in the pre- and postoperative period did not differ significantly in most parameters of the blood chemistry tests. At the time of discharge, 60 (93.7%) patients in the main group and 49 (81.7%) patients in the comparison group had clinical improvement, which indicates a positive trend in wound healing (Pearson’s chi-square 3.19; p=0.08). There were no adverse events associated with the drug during the observation period.

Conclusion. Phlogenzym® in the standard of care for the pre- and postoperative period in the surgical treatment of POP is able to favorably influence on the mobile mechanisms of the repair of damaged tissue and stabilize the blood chemistry parameters, which presumably should be associated with the optimization of repair processes in the vagina. The results obtained and the absence of any side effects characterize Phlogenzym® as a drug with a favorable clinical profile for use in the pre- and postoperative period.

Uterine fibroid (UF) is the most common benign tumor in the structure of gynecological diseases of the female reproductive system, accounting for 45–70% of the total cases. Special attention should be paid to the rare cases with gigantic UFs. The management approach to patients with gigantic UFs is determined by the age of the patient, her desire to bear a pregnancy and realize reproductive function, as well as the presence of comorbidities. Therefore, an individualized approach is essential. The paper describes a clinical case of a patient with a gigantic UF that grew due to the lack of proper medical care for a long time. The patient underwent panhysterectomy, resection of the greater omentum, and ligation of the internal iliac arteries. This case is a clear example of the forced extension of the surgical procedure due to the tumor size, which is associated with an increased risk of surgical complications

Hyaluronic acid (HA) is a key component of the extracellular matrix involved in regulating inflammation, fibrosis, and tissue repair. Its biological properties depend on molecular weight: high-molecular-weight HA (HMW-HA) exhibits anti-inflammatory effects, whereas low-molecular-weight fragments (LMW-HA) induce inflammation and fibrosis by activating CD44, TLR, and RHAMM receptors. An imbalance between these forms may contribute to chronic inflammatory and fibrotic processes. HA metabolism is regulated by synthases (HAS) and hyaluronidases (HYAL). During chronic inflammation, HYAL-2 degrades HMW-HA into LMW-HA, which accumulates and sustains the inflammatory response. Native hyaluronidase preparations have limited efficacy due to rapid inactivation. Conjugation of the enzyme with azoximer enhances its resistance to inhibitors and proteases while prolonging its action. Bovhyaluronidase azoximer (Longidaza) breaks down pro-inflammatory LMW-HA into safe ultra-low-molecular-weight fragments, suppressing inflammation and fibrosis. The drug is active in the acidic environment of inflamed tissues without damaging healthy tissue. Its anti-fibrotic and anti-adhesive properties have been confirmed experimentally and clinically. Clinical studies demonstrate the drug’s efficacy in various fields: preventing postoperative adhesions, treating fibrotic changes in pulmonology, and correcting scars in dermatology. Thus, modulation of HA metabolism using conjugated hyaluronidase represents a promising approach for managing chronic inflammatory and fibrotic conditions.