Objective: assessment of the feasibility and safety of the use of ulipristal acetate on the basis of the clinical and morphological study.

Materials and methods: the study involved 78 women with leiomyoma, abundant menstruation and anemia. Group I – 43 patients who underwent ulipristal acetate therapy for three months and then laparoscopic myomectomy. Group II – 35 patients who were myomectomyed without presurgical preparation. A comparative analysis was made of the clinic-laboratory data, operational parameters, pathomorphological changes in the nodes and endometrium. According to the original clinical laboratory study groups I and II were almost homogeneous.

Results: in the case of ulipristal acetate therapy in all group I patients uterine bleeding ceased, the size of the myomatous nodules decreased by an average of 25 per cent according to the ultrasound and the MRI (p < 0.05), the haemoglobin and the ferritin levels reached normal values (p < 0.01). In group I there was a decline in the duration of the operation and blood loss compared to group II. Some leiomyoma reduction mechanisms have been identified. In endometrium of group I patients drug pathomorphosis after therapy was diagnosed. However, the immunohistochemical study made it possible to establish that these changes were benign and reversible.

Conclusions: presurgical treatment by ulipristal acetate of reproductive age patients with myomas, uterine bleeding and anaemia is appropriate, safe and pathogenetically justified. The possibility to use repeated courses of the drug, which may eventually postpone or cancel the need for surgical treatment is promising. 

The premenstrual syndrome (PMS) is a pathological symptom that significantly reduces the quality of a woman’s life. The etiology and pathogenesis to date have not been sufficiently studied, but the diagnosis, treatment and prevention that are to be complied with have been identified. The treatment of the PMS should be differentiated, taking into account the overall and reproductive health of the woman, the concomitant diseases, the degree of severity of ICP, the portability of therapy, etc.

Cervical cancer is one of the most common localized tumours of the female genital sphere. According to WHO, 16 710 new cases of cervical cancer were registered in Russia in 2015. 6,628 patients died of the progression of the malignant process of this localization in 2015. The standardized morbidity rate in 2015 was 15.1 per 100 thousand of population [1, 2].

The article discusses the differential treatment of iron deficiency anaemia and how it is effectively adjusted in the post- natal period using various iron-containing drugs and methods of introduction. A comparative study of the use of intravenous drugs has been carried out: iron carboxymaltosate (iii), iron (iii) hydroxide oligoisomaltosate and oral use of iron (III) hydroxide polimaltozate.

The article presents a clinical case of management of pregnancy in a woman with medical history signficant for obstetric and thrombotic events. After a thorough examination of the hemostatic system the role of genetic and acquired thrombophilia was identified. From a modern point of view thrombophilia is considered to be the etiopathogenetic factor for a wide range of diseases and syndromes – fetal loss syndrome, preeclampsia, thromboembolic complications of hormonal contraception and hormonal replacement therapy. The role of anticoagulant and antiplatelet therapy is discussed, in particular the use of dipyridamole in  obstetric practice.

Hormonal contraception continues to be one of the most effective methods of protection against unwanted pregnancies. Many research trials are aimed at improving of various methods of hormonal contraception, which in turn allows couples to plan for pregnancy. Combined oral contraception is one of the most common methods to prevent unwanted pregnancies worldwide. To date hormonal contraceptives differ between the way they are introduced into the body, the mode of indication, the expression of gestagenic influence, the presence or absence of androgenic, antiandrogenic, antimineralocorticoid, glucocorticoid and other activity.

The use of long-acting contraceptive methods of the Long-Acting Reversible Contraception (LARC), to which the LNG-IUS belongs, with adequate and rational counseling can exercise not only a contraceptive, but also a preventive task in the treatment of disseminated gynecological diseases. Three clinical cases with the analysis of errors in the management of the patients are considered.

The premenstrual syndrome (PMS) is a complex pathological symptom manifesting itselft through variety of neuropsychiatric, vegetative-vascular and metabolic-endocrine disorders that affect the quality of life of patients and reduces their working ability.

The treatment of PMS starts with the selection of diets, correction of the working and rest periods and the maximum reduction of psychoemotional stress. For the purpose of pharmaceutical effetc hormonal therapies, psychotropic drugs, nonsteroid antiinflammatory drugs, diuretics, plant and homeopathic drugs, vitamins are used. The most pathogenetically reasonable is hormonal therapy.

The use of combined oral contraceptives enriched by folates as a way of PMS therapy has an additional effective impact on the nervous system, contributes to the stabilization of the central neuroregulatory mechanisms and reduces the expression of  emotional and affective symptoms and cognitive disorders.

Dienogest is a highly effective drug for treating the major pain symptoms of endometriosis (chronic pelvic pain, dyspareunia and dysmenorrhea) and preventing a relapse with a high safety profile and good tolerability allowing to indicate it for longterm treatment of the disease. The latest data reflecting the full impact on the various links of the pathogenesis disease testify in favour of the choice of the specified progestagen.

The frequency of iron-deficiency conditions (IDC) in pregnant women in the world ranges from 25 to 50% at the average. In developing countries, their prevalence ranges from 35 to 75%, and in developed ones amounts to 18-20%. According to the Ministry of Health of Russia, the average frequency of IDC in pregnant women in Russia ranges from 39 to 44%, and in postpartum women – from 24% to 27% [1–3].

Iron deficiency (ID) adversely affects pregnancy, childbirth, postpartum period, fetus and newborn conditions, contributing to the increase in the frequency of threatened abortion, placental insufficiency, delayed growth and fetal hypoxia, premature birth, uterine inertia, frequency and volume of pathological blood loss in childbirth and the early postpartum period, infectious complications and hypogalactia in postpartum women. Iron supplementation to prevent reduces the risk of anemia in motherto-time delivery by 70% and iron-deficiency States by 57%.

In the modern market of pharmaceutical industry the drug Sorbifer Durules has been well established (EGIS, Hungary). The use of this drug in a large sample of pregnant and postpartum women in recent years has proved its efficacy in the treatment of ID in this patient cohort. 

The article provides major provisions of the preconception preparation. The practicability of diagnostic and therapeutic and preventive measures at preparation to pregnancy as well as the role of the family planning in prevention of obstetrical and perinatal complications is justified.

The abstract highlights the evolution of the doctrine of thrombophilia, prsents a new perspective on factors of thrombogenic risk and the thrombotic state of readiness preceding and accompanying the critical vascular ischemia. Their own results and results of other authors are provided on the use of generation 2 low molecular weight heparin - bemiparin sodium for prevention of thrombotic and gestational complications in the practice of obstetrician-gynecologist.

The aim of the study was to compare the efficacy of tocolytic agents - hexoprenaline and atosiban taking into account the gestational age.

Patients and methods. The study included 147 pregnant women with threatening preterm labour between 28 to 33 weeks of gestation. Seventy-three pregnant received tocolysis by hexoprenaline (36 of them before 28 weeks of gestation and 37 – 32 weeks and more) and 74 – atosiban (39 of them before 28 weeks of gestation and 35–32 weeks and more). There were no differences in the clinical condition of pregnant women and features of preterm labour among groups before start of the tocolysis.

The degree of effectiveness is determined by the duration of the pregnancy prolongation (48 hours, 7 days, more than 14 days).

Results. Depending on the gestational age women that received hexoprenaline tocolysis prolonged pregnancy for 48 hours in 80,6% and 81,1%, whereas in the treatment with atosiban in 94,9% and 100%. Full-term gestation births occurred in 24,3% after hexoprenaline tocolysis at 32 weeks and more and in 51,4% with – atosiban (p < 0,05%). On average, atosiban tocolysis allowed to prolong pregnancy by 6–10 days longer than hexoprenaline (p < 0,05).

Conclusion: The results of study have shown that atosiban was more effective tocolytic than hexoprenaline in the treatment of threatening preterm labor in both 28-32 and 32 or more weeks of gestation. The efficacy of atosiban slightly increased with gestational age from 28 to 33 weeks. 

Nutrition is an important factor affecting human health. Food, unlike other factors of the environment, is becoming an internal organism instead of the external one, becoming a structure of the body, energy and construction material for growth and development. The deterioration in the quality of nutrition in general among the population is an unfavourable factor for the individual, especially for women who are preparing for pregnancy, not to mention those who are already ready to become a mother and to deliver a child. At present, the rapid advances in science and technology have brought about tremendous changes in the technologies for production and storage of products. New food products, their production methods emerged that are not always environmentally friendly, balanced in substances and do not necessarily cover the need in micronutrients and vitamins. Food is very often contaminated by various chemicals: Nitrates, nitrites and mass of other unacceptable xenobiotics (especially preservatives, stabilizers and dyes that make up the products, the most common of these is tartrazine).

The embolism of the pulmonary artery is a sudden stoppage of blood flow in the pulmonary artery branch due to a clot or embolus, which is part of the thrombosis syndrome of the upper and lower vena cava. These diseases are now treated as components of a single pathological venous thromboembolism.

The article considers the issues of the complex therapy for recurrent miscarriage, including in addition to hormonal support, correction of hypercoagulation and thrompbophilic changes of hemostasis, that are often associated with the chronic viral infection. The study of effectiveness of sodium enoxaparine use as part of the complex therapy aimed to prolong the pregnancy in the first trimester, subcutaneous injections of sodium enoxaparine compared to the peroral use of dipyridamol. The hemostasiogram changes and therapeutic outcome were analyzed in this cohort of patients.

Preterm birth is one of the most important problems of modern obstetrics. The etiology of preterm birth is multifactorial, including the maternal and fetal complications, on the background of functionally vulnerable variants of many genes, therefore preterm birth is considered as the big obstetric syndrome. One of the anatomical components of the syndrome is the uterine cervix. Frequently, in singleton pregnancy, single-most reliable prognostic marker is the untimely maturation of the cervix due to increased uterine contractile activity.

The selection of correction method for the short cervix relies on the clinical conditions, history, gestational age, number of fetuses, cervicometry data, gynecological examination data, threatening preterm birth or pregnancy loss, and the experience of the physician. Insertion of obstetric pessary is a promising, safe, simple method for treatment and prophylaxis of cervical insufficiency and threatened termination of pregnancy in II and III trimesters. The strategy of broad use of pessaries in the group of high-risk pregnant women allows to reduce the frequency of preterm birth and improve perinatal outcomes. 

In recent years viral infections take the worldwide leading place due to their damaging effect on the body in general and reproductive system in particular. Herpes infection is a serious medico-social problem, which is one of the most common human viral infections. More than 90% of the population worldwide are infected with one or more serotypes of the herpes virus. Recurrent herpes virus diseases affects 2--12% of the population.

Uncomplicated infection of lower urinary tract is one of most common reason to visit a doctor among women. Statistically there are about 36 million cases of acute cystitis registered yearly in Russia. The treatment of acute cystitis is usually empirical, that’s why it is very important to know etiology of the disease. There are some criteria for drug choice for the disease treatment: the sensitivity range of uropathogenic microflora, the effectiveness of a preparation based on clinical trials, tolerance of the patient to the antibacterial drug, low risk of collateral damage, availability of the drug and its price. The author has assessed the treatment effectiveness of Urofuragin (Furazidinum) preparation in case of acute cystitis. This drug is high active against main causative agents of the infection diseases of lower urinary tract. Due to the results of the research cupping of dysuria, hematuria and pain syndrome were recorded in all clinical groups on the 2nd-3rd day of treatment. Normalization of urinalysis had place in 98% of cases (51 patient). Only 4 patients (7,6%) had unwanted side effects during the treatment time: nausea, loss of appetite. All the unwanted side effects were poorly expressed and didn’t require to withdraw the treatment. The results of this research show that Urofuragin (Furazidinum) is an effective antibacterial preparation which is easy to use, has affordable price, wide indications and good tolerance to the drug.

Myoma of the uterus occupies the third place in the structure of gynecological pathology, second only to inflammatory diseases, the main symptoms of uterine fibroids are profuse menstruation, pelvic pain, infertility, impaired function of neighboring organs characteristic of tumors of large sizes. Treatment of uterine fibroids «an urgent problem of modern gynecology», despite the variety of therapeutic techniques. Uterine myoma is a frequent cause of infertility, the pathogenesis of which is not fully understood. Recently, as a drug of choice for the purpose of adjuvant therapy of uterine fibroids, the drug mifepristone has been widely used, which has a high therapeutic efficiency, which contributes to the realization of the reproductive function in the conduct of organ-saving operations.

Currently one of the problems presenting considerably clinical difficulties is the immune factor of the male infertility. In the structure of reasons of the male infertility, according to various literature sources, the immune factor is present in 5-15% of the number of infertile couples. The frequency of ASAB detection in patients in the infertile marriage considerably varies depending on many reasons making at the average 15% for men and for women it’s twice as high – 32% [1–3].

Over the past few decades the incidence of infertility and sub-fertility has increased significantly, particularly in developed countries. External environmental factors, such as air and soil pollution, contact with different chemicals, are consdiered as the cause of both female and male fertility decline. Various lifestyle factors, such as nutrition, chronic diseases, stress, allergies, smoking and alcohol consumption, are also seen as potential causes of fertility decline.

The toxic effects of various harmful substances on a reproductive human system can lead to a disruption of the synthesis of steroid hormones, as well as to the direct damage to the tissue of reproductive organs. It is known that the main pathological mechanism for the negative effects of toxic substances on reproduction is the development of oxidized stress, an important component of various serious human diseases.

Antioxidants are a group of medications that neutralize the free radicals. Antioxidants include various vitamins, minerals, as well as polyunsaturated fatty acids. Various antioxidants (in the form of biologically active additives) and multivitamins are often indicated as preconception training for women and men who are planning a natural pregnancy and are experiencing a fertility problem or patients in the preparation for the program of auxiliary reproductive technologies (ART). The purpose of the drugs is to increase fertility and increase the effectiveness of the ART program, but the efficacy of such therapy has not been definitively defined.

This literature review provides the up-to-date literature data on the effects of vitamin A, C, E, omega-3-polyunsaturated fatty acids, melatonin and the Q10 coenzyme on various aspects of the human reproduction function. 

The epithelium of the mucous tunic of the vagina and urethra is the most sensitive to the shortage of estrogens, hence, in the development of the genitourinary syndrome in menopause compensation of the estrogen deficit is the simplest and  safest method of treatment. This article contains the results of a questionnaire on the diagnosis and treatment of GUSiM by the Russian obstetricians, with the use of topical estrogens.

Effective dietary modification in the form of use of rationally designed biologically active additives (BUD) offers prospects for improving quality of life of patients with moderate symptoms of hot flashes. The micronutrients introduction results in a complex impact on the woman’s body: it stimulates own body reserves to maintain the hormonal balance and to normalize the psychoemotional state, which is clinically reflected in the lowering of the hot flashes frequency and the improvement of the quality of life of the patients. The authors analyzed the experience of use of the biologically active additive MENSE in patients with vegetovascular disorders and psychoemotional disorders during the menopause. During the observation period, the observed decrease in the Kupperman index amounted to 1.7 times on average for the entire group of patients. In the group of patients with an initially average gravity the climacteric syndrome by Vikhlaeva scale, the number of hot flashes was reduced by more than 1.5 times; in the of patients with an initially slight menopause syndrome - by more than 2 times.

Relevance: According to the literature, Vulvovaginal candidiasis (VVC) is diagnosed in 75% of women during life, and in 5-8% of women its recurrent course is developed (four or more episodes of exacerbation during 12 months). Recurrent vulvovaginal candidiasis (RVVC) is often observed in the presence of development risk factors, but often the recurrent course of the disease is developing among women without obvious risk factors. The literature shows that the development of a recurrent fungal infection is often caused by a violation of the local immune response, which is associated with the polymorphism of the immune system genes.

Objective of the study: To develop criteria for forecasting the recurrent current volvovaginal candidiasis to improve the effectiveness of therapy.

Study results: As a result of our study, it has been found that C. albicans remains the leading fungal species in the acute and recurrent VVC, but women with the recurrent course of VVC the prevalance of non-C. Albicans fungi is reliably higher than the patients with acute VVC (P = 0.037). Also, the sensitivity data obtained shows that most of the studied yeast fungi (97.5%) are sensitive to fluconazole. However, only in 10.5% of the non-C.Albicans strains resistance was detected. The determination of genetic predisposition to develop the recurrent current VVC, using the prediction model derived from our study, revealed that 77.8% of women with a genetic predisposition are developing a relapse of VVC. In view of these results and based on international recommendations (CDC, WHO, 2011) that it is appropriate to indicate the anti-recurring antifungal treatment to RVVC, it can be concluded that for patients with genetic predisposition to the development of recurrent VVC it is advisable to indicate the anti-recurrent antifungal therapy. 

A new method of combined therapy of cervical pregnancy with combined use of uterine artery embolization and temporary balloon occlusion of internal ileal arteries, which could retain the reproductive function of the woman.