The article addresses matters related to the replenishment of the magnesium deficiency in pregnant women. Two multicenter studies conducted in Russia in 2012 and 2013 showed that magnesium deficiency was diagnosed in 81% of pregnant women. The presented article states that the magnesium status study has some limitations and should be comprehensive, including the symptom assessment using MDQ questionnaires and the measurement of the level of magnesium in the blood by laboratory tests. This work assessed the effects of magnesium deficiency on pregnancy outcomes. The systematic reviews of randomized clinical studies in pregnant women without magnesium deficiency did not detect the positive effect of magnesium supplements on reduction of the incidence of complications, and, on the contrary, if the magnesium deficiency is diagnosed, the frequency of complications, including gestational hypertension, preeclampsia, premature birth, low birth weight has been significantly reduced. The article discusses the issues of hypomagnesemia diagnosis and rational therapy with magnesium supplements and provides the analysis of the data on bioavailability, accumulation rate, dose determination, possibilities and feasibility of administration combined with other micronutrients. If the magnesium deficiency is diagnosed, it is necessary to replenish it with a combination of organic Mg-containing agents and pyridoxine at adjusted dosages. The advantages of oral magnesium citrate compared with other salts are due to its high bioavailability, delivery of magnesium to the cells, and complete utilization in the Krebs cycle. The intake of vitamin-mineral complexes for pregnant women is not a limitation for taking additional magnesium-containing supplements in women with Mg deficiency.

Among gynaecological diseases in women of reproductive age the leading place is occupied by inflammatory diseases of the lower part of the genital tract (70%), a significant proportion of which are inflammatory processes of the vagina and cervix uteri. In ⅔ of women, cervicitis is most often asymptomatic, so they do not seek medical treatment, and 65–77.6% have a transition to a chronic form. Thus, chronic cervicitis is diagnosed in almost one in three women who seek assistance from a gynaecologist due to leukorrhea, and there is no tendency for a decrease in frequency. The article presents an actual view on the problem of inflammatory diseases of the lower genital tract. The analysis of some researches devoted to the influence of local immunity and the state of vaginal microflora on the development of chronic inflammatory diseases is carried out. The results of proteomic researches of cervicovaginal fluid in early diagnostics of inflammatory diseases of the lower genital tract and the possibility of using cytokine biomarkers in clinical practice with the aim of prediction of pathological state and choice of further treatment tactics of the patient are presented. Efficiency of use of the combined medication on the basis of chlorhexidine and dexpantenol possessing pronounced antimicrobial, regenerating and metabolic action and applied in therapy of acute and chronic vaginitis; bacterial vaginosis; endo-, exocervicitis that is topical in therapy of inflammatory diseases of the lower genital tract is considered.

Introduction. A genital human papillomavirus infection receives the sword-point attention of both researchers and practitioners, due to its large prevalence in the human population, high contagiousness and, in particular, the ability of some HPV strains to contribute to the development of malignancy. This is particularly so with cervical cancer (CC), one of the most common types of cancer both in the Russian Federation and most countries of the world. It ranked first among the causes of malignant tumour deaths of women aged over 30 years. Objective. To present the experience in using the 3,3’-diindolylmethane-containing drug in the treatment of patients with HPVassociated low-grade cervical intraepithelial lesion. Material and methods. 62 women with HPV-associated low-grade cervical intraepithelial lesion were examined and received treatment with the 3,3’-diindolylmethane-containing drug (Cervicon-DIM). The primary diagnosis and therapeutic outcomes monitoring included the following research methods: colposcopy, histological examination of biopsy cervical specimens, Pap test, RT-PCR of high carcinogenic risk (HCR) HPV. The therapy compliance was evaluated using the clinical psychological test method (Morisky Green scale): compliant patients 4 scores (noncompliant 2 scores or less, insufficiently compliant 3 scores). Results. The therapeutic outcomes using 3,3’-diindolylmethane-containing drug (Cervicon-DIM) in the form of vaginal suppositories (100 mg twice daily for 90 days) showed clinical (recovery of colposcopic status in 83.0% of patients), cytological (confirmed absence of LSIL in 98.3% of women) and microbiological (PCR-negative HCR HPV in 91.5% of women) efficacy with satisfactory tolerance of the drug. Сonclusions. The therapeutic outcomes obtained using 3,3’-diindolylmethane-containing drug in the treatment of patients with HPV-associated low-grade cervical intraepithelial lesion could be considered as satisfactory. The data presented may be of interest to practicing gynecologists and other specialists.

Introduction. Gynecological morbidity in adolescents and young women is presented predominantly by functional disorders that do not have a distinct organic substrate and develop as response to stress factors. Objective: to evaluate the response of the menstrual cycle to the cyclic intake of vitamins and plant extracts in adolescents and young women with stress-dependent menstrual disorders. Materials and methods: The observational study included 40 women aged 16–28 years with anovulatory normogonadotropic ovarian dysfunction that clinically manifested as abnormal uterine bleeding (n = 7), oligomenorrhea (n = 29), or amenorrhea (n = 4). The subjects were recommended a 12-week administration of Time Factor vitamin-plant complex as a food supplement. The examination included the assessment of clinical parameters, hormonal blood profile and autonomic balance, ultrasound monitoring before use and in the 3rd cycle of Time-Factor complex administration. Results: the autonomic dysfunction symptoms reversed to an acceptable level in 62.5% of patients, the average score of autonomic dysfunction decreased from 33.8 ± 11.7 to 16.8 ± 3.87 points (p < 0.001) in 12 weeks’ time. The menstrual intervals reduced from 51.2 ± 11.5 to 32.5 ± 16.2 days (p < 0.01) in 65% of women. Ovulation in the final complex administration cycle was reported in 25% of women. Positive dynamics of folliculogenesis, endometrial thickness and hormone levels in plasma were also observed. Conclusion. The use of Time Factor biologically active complex in adolescents and young women with stress-dependent menstrual disorders improves autonomic balance, quality of life and has a positive effect on the menstrual cycle characteristics. The method is effective for oligomenorrhea-type menstrual disorders and should not be used as the only remedy in patients with amenorrhea or abnormal uterine bleeding.

Introduction. The vaginal microflora has a direct impact on the health of a newborn child, as well as during the postpartum period in new mothers. The composition of the vaginal microflora of a new mother determines the microflora of her conjunctiva, gastrointestinal tract, and the skin of the newborn, which are identical to the microflora of the mother’s birth canal, and the risk of infection in newborns is directly related to the degree of amniotic fluid insemination. At least half of women have some kind of vaginal microcenosis disorder during pregnancy. In the course of the study, the peculiarities of vaginal microbiota in a full-term pregnancy were studied and the effectiveness of correction of vaginal microcenosis abnormalities when applying the preparation Gaynomax was assessed.

Aim of the study. To study the peculiarities of the vaginal microbiota in case of full-term pregnancy and to evaluate the effectiveness of correction of its abnormalities when applying the preparation Gaynomax.

Materials and methods. On the basis of City Clinical Hospital No. 40, separate subdivision “Maternity hospital“, clinical and diagnostic department 72 pregnant women in the gestation period of 37-39 weeks the analysis of microscopic examination of vaginal swabs culture and sensitivity test was performed. The analysis included the results of a microscopic study of vaginal and cervical swabs stained using the Gram method. Bacteriological analysis of the vaginal content by cultivating aerobic and anaerobic microorganisms on special nutrient media. PCR method with real-time detection of results (Femoflor 16), including the determination of a wide range of microorganisms. To obtain adequate results, only samples with a sufficient number of cells caught in the test tube with the analyzed sample and sufficient total bacterial mass were used. Samples in which the number of DNA of human cells was more than 104 genome equivalents (GE) in the sample were taken into account, this is a swab quality indicator (SQI).

The results: In pregnant women with high frequency infectious risk group, vaginal dysbitoic conditions were revealed with development of bacterial vaginosis, vaginal candidiasis and nonspecific vaginitis. Vaginal sanitation was carried out in patients. Excellent effect was obtained in 33/72 (49,2%) women, good effect in 21/72 (31,4%) patients, satisfactory in 13/72 (19,4%), which indicates fully justified expectations from the chosen treatment method. Conclusion: The use of Gaynomax vaginal suppositories is a reasonable and quick method of vaginal sanitation before delivery.

Constipation is one of the most common problems. About half of pregnant women experience stool retention, which occurs due to maternal physiological changes in pregnancy: the action of progesterone, uterine growth and other causes, can cause complications of pregnancy, childbirth and the postpartum period and requires treatment. However, this condition is not discussed enough among obstetrician-gynecologists. In the authors’ opinion, the importance of the problem is underestimated. The clinical data provided in the text of the article show that intestinal biocenosis disorder due to chronic colostasis in pregnant women can become a predisposing factor for bacterial vaginosis. In addition, constipation in pregnancy is one of the risk factors that may increase the rate of preterm birth, premature rupture of membranes, birth of small-for-date babies and other complications. For these reasons, the problem demands close attention of the medical community. The article provides basic information about the causes, endocrine, metabolic and other prerequisites for constipation, the features of their manifestations during pregnancy, possible complications, modern pharmacological and non-pharmacological treatments and lifestyle correction capabilities. The authors provided a list of essential drugs to treat constipation, described indications and contraindications for use of such drugs during pregnancy and listed side effects. Sodium picosulfate may be used in the second and third trimesters, which restores the passage of stools in the intestine in a short time and is not contraindicated in a pregnancy. Consideration has been given to the usage of the drug in the practice of obstetrician-gynecologists.

The review provides information on the medical treatment of uterine fibroids (MM) in a comparative aspect. MM are one of the most common gynecological diseases requiring surgical intervention in the presence of symptoms. As a drug treatment, gestagens and their combinations with estrogens, which did not demonstrate reliable efficacy, were the first to be proposed. Later, obvious advantages of using GnRH agonists/antagonists that cause the effect of “central” chemical castration were discovered, and therefore their use is limited to 6 months, and they are successfully used to prepare patients for surgery. Recently, non-peptide orally active GnRH receptor antagonists have been proposed that are in the early stages of clinical trials. However, changes in the dosage form and route of administration of drugs that inhibit the activity of GRH do not improve their safety profile. Another breakthrough in MM therapy has been the use of selective progesterone receptor modulators, previously called “antiprogestins.” The drugs of this group have comparable efficacy and better tolerance to AGnRH, which makes the possible long-term treatment of uterine fibroids, especially in premenopausal women, using these drugs.

Protection of women’s reproductive health and fertility is one of the priorities for the modern medicine. The prevention of an unintended pregnancy is critical for successful solving of this problem. Prevention of unwanted pregnancy and abortion, medical and social counselling are an integral part of the obstetrician-gynecologist activities. The effectiveness of preventing an unwanted pregnancy is a major factor in choosing a remedy, as well as the ease of use. The article presents information on the new modern contraception methods, including prolonged forms of combined hormonal contraception. A comparative analysis of oral and parenteral contraceptives is provided. The authors gave criteria of efficacy and principles for rational choice of contraceptives. The mechanism of action of a hormonal contraceptive drug containing etonogestrel and ethinyl estradiol is described. The article reviews the main advantages, indications for use and side effects of hormonal releasing systems, which contraceptive effect is provided by a combination of various factors. The suppression of ovulation is the most important of these factors. The researchers provided an analysis of the effect of the vaginal hormonal ring on the biocenosis of vagina and cervical mucosa, on the course of background cervix diseases and the possibility of preventing the development of pathogenic flora, as well as the benefits of its use in women with uncomplicated ectopia of the cervix: the effect on the epithelization of ectopia of columnar epithelium and the beneficial effect on endometrioid heterotopia. The article presents data on the frequency of adverse effects associated with the use of the contraceptive method, as well as risk factors that may become a contraindication to the use of the vaginal hormonal ring. Clear guidelines for postabortion contraception are provided.

The implementation of the reproductive function is one of the main components of women’s quality of life. Despite significant progress in the treatment of infertility and prevention of reproductive losses, these problems are still relevant. It is also important to timely diagnose various pathological processes in order to determine the tactics of preparing women for pregnancy and its further management, taking into account the pathogenetic characteristics of diseases. Various attempts have been made to optimize both diagnostic and therapeutic approaches. Special attention is paid to identifying risk groups and ensuring the most effective preparation for pregnancy, taking into account possible risk factors for adverse outcomes. Adequate diagnostics of background pathology and the use of proven effective methods of pregravid preparation can significantly improve pregnancy outcomes. Peculiarities of the vascular system functioning may affect both the life of the woman in general and the outcome of pregnancy. Endothelial dysfunction is a component of pathogenesis of many nosologies (diabetes mellitus, chronic venous disease, hypertension, autoimmune pathology, etc.). Restoration of vascular endothelial dysfunction and, as a consequence, prevention of probable vascular complications is one of the new goals in the preventive approach to pregnancy. The promising center of this approach is considered to be the drug sulodexide. The three main effects of this drug – antithrombotic, anti-inflammatory and defensive in relation to endothelium – provide a significant increase in pregnancy preparation possibilities in many nosologies. This review presents its main features and areas of use.

Habitual miscarriage is a fairly common complication of early pregnancy. In the opinion of most authors, the term habitual miscarriage is used to describe a loss of two or more pregnancies during the first 22 weeks of pregnancy. Issues of terminology and management continue to be relevant and debatable in medical professional communities and need further discussion. In addition to the medical sides of the issue, habitual miscarriage has a significant psychological impact on women and their partners. Regardless of the gestational age, the loss of pregnancy for most couples is similar in importance to the loss of a newborn and is associated with the loss of hope and plans that future parents connected with a baby who has not yet been born. After repeated losses, bereavement and emotional upheaval are further exacerbated irrespective of the term of abortion. Repeated pregnancy loss is a significant negative event in the life of a couple both from a medical and psychological point of view, that’s why the provision of adequate medical care is one of the objectives of a specialist managing pregnancy. This also involves the choice of effective disease management. Previously it was shown that luteal phase deficiency might be the cause of this phenomenon, and that hormonal deficiency had to be replenished. Many modern publications confirm that progesterone and its derivatives have an important immunomodulatory role in the habitual miscarriage. The article describes the role of progesterone in maintaining pregnancy and the results of studies devoted to the role of dydrogesterone. It also presents data of international studies on the treatment of women with habitual miscarriage.

Adequate balanced nutrition of a woman is one of the most important aspects at the stages of pregravid preparation, during pregnancy and lactation. The needs for vitamins and minerals increase by 20–50% during pregnancy and lactation. Considering that the mother’s body is the only source of vitamins and minerals for the growing and developing fetus, adequate nutrition of the mother becomes one of the underlying determinants of the development period of the child’s health in the future. Particular attention should be paid to the supplement of folates, iodine, iron, omega-3 fatty acids and vitamin D. These microelements are critical to the healthy development of the fetus, the prevention of preeclampsia, gestational diabetes, premature birth and fetal congenital anomalies. However, the studies show that a significant number of women suffer from shortage of vitamins and minerals during pregravid preparation, pregnancy and lactation. Moreover, a combined deficiency of three or more vitamins is identified in 70–80% of the examined women, regardless of age, region of residence, occupation and season. In cases when a woman fails to achieve an adequate and balanced diet during these periods, vitamin and mineral support helps reduce the risk of pregnancy complications and fetal congenital anomalies. An individual differentiated approach to the prescription of vitamindoimineral complexes for women in these periods is perspective in terms of effective prevention of pregnancy complications and fetal congenital anomalies. The article discusses the principles of adequate vitamin deficiency prevention at the stage of pregravid preparation and at different stages of pregnancy.

The article is devoted to the issues of prevention and choice of therapy strategy for iron deficiency anemia in pregnant women. Iron deficiency anemia is a frequent complication during pregnancy and in the postnatal period. According to the World Health Organization (WHO), the frequency of anemia in pregnant women exceeds 40% and can reach 65% in developing countries. More than half of all cases of anemia during pregnancy are directly related to iron deficiency (ID), which can be as high as 80% or more during pregnancy. This indicates that existing iron reserves out of pregnancy are inadequate to compensate for the increasing need for iron intake during pregnancy. According to domestic authors, the vast majority of women have some kind of iron deficiency by the end of pregnancy, and some of them had a latent iron deficiency even before pregnancy. The development of anemia is preceded by sublatent and latent forms of iron deficiency associated with increased iron demand during gestation. The issues of early diagnostics of preclinical forms of iron deficiency with subsequent correction of this element insufficiency, which allows avoiding undesirable phenomena related to the development of anemia, remain particularly relevant. The prevention of iron deficiency anemia should be complex and individual, and the choice of a drug to compensate for iron deficiency should be based on high bioavailability of the drug with minimal side effects. According to available data, oral administration of bior trivalent iron preparations is not sufficient for the treatment of moderate to severe anemia. In this case, the administration of iron sulphate preparations should be combined with the prescription of prolonged or recombinant erythropoietin with a transition to intravenous administration of iron preparations.

Cardiotocography (CTG) is the main method of assessment of the fetus, which due to its informativeness and stability of the information obtained has almost completely replaced the phonoand electrocardiography of the fetus from the clinical practice. A CTG can be used to monitor the fetus during both pregnancy and delivery. Depending on the presence or absence of risk factors, internal or external CTGs are now used. Knowledge of the basic principles, definitions and concepts of CTG, its classification, as well as accumulated clinical experience, helps to interpret the results obtained and improve the outcomes of childbirth. CTG data should be considered in combination with the clinical situation in order to select the correct management of birth tactics and decide on the method of delivery. A recording made during delivery is a medical document that can be used for a comprehensive assessment of the course of delivery, as well as for legal protection of the clinician in complex situations. However, the method has insufficient specificity regarding the diagnosis of acute hypoxia. At present, there are no methods to accurately predict fetal hypoxia, and therefore, to solve this problem, CTG should be routinely performed on all new mothers. Increased experience with CTG helps to interpret the results and improves the outcome of childbirth. However, the method of delivery is always determined by the clinical situation. Despite the wide practical application of CTG, a number of unresolved issues remain, which requires further development of fetal monitoring methods.

The article describes the basic rules for the selection of a systemic antifungal drug from the fluconazole-based preparations available on the Russian pharmaceutical market. Questions of interchangeability of generic and original drugs, research of equivalence (pharmaceutical, pharmacokinetic), possible methodological difficulties of its estimation are discussed. Data on comparative analysis of original and generic fluconazole drugs are presented. The algorithm of rational choice of a drug on an example of fluconazole is formulated, property of a drug to suppress selectively activity of fungi of genus Candida, not showing hepatotoxic drugs, and also questions of correlation between reference and generic drugs on the basis of fluconazole is considered. The Federal Law “On Amendments to the Federal Law “On Circulation of Medicines“ No. 429-FZ (adopted on December 22, 2014 and entered into force on July 1, 2015) regarding the establishment of the procedure for determining the interchangeability of drugs, states: “Information on the interchangeability of drugs shall be included in the State Register of Medicines from January 1, 2018“. The law discloses the notion of interchangeable drugs, which “means a drug with proven therapeutic equivalence or bioequivalence regarding reference drugs, having equivalent qualitative formula and quantitative composition of active substances, formula and method of administration“. However, some definitions used so far in the law have been changed. Thus, instead of the term “original medicine“ the term “reference drug“ is used from July 1, 2015, which is defined as a medicine first registered in the Russian Federation, the quality, efficacy and safety of which has been proved based on the results of preclinical and clinical studies, and which is used to assess the bioequivalence or therapeutic equivalence, quality, efficacy and safety of generic or bioanalogue medicine. However, this article still uses the terms “original“ and “generic“ drugs, which are familiar to our medical community.

Optimizing the management of patients with HPV-associated cervical diseases remains a priority for the modern studies on this issue. The human papillomavirus is divided into two types: high-risk and low-risk types according to its malignant potential to cause cervical cancer and some other oncological diseases. Human papillomavirus can clear spontaneously in 85-90% cases, but the risk of cervical intraepithelial neoplasia and invasive cervical cancer is quite high in persistent high-risk oncogenic infection. The virus presence in the body tissues cannot be considered as a marker for progression or regression of the pathological process in the strict sense, even though cervical intraepithelial neoplasia and cervical cancer develop in HPV-positive patients in the vast majority of cases. These studies are aimed at searching for the new and improving existing methods for early diagnosis of precancerous diseases and cervical cancer. The development of the HPV-associated pathological process is known to be dependent on the human immune system status. The virus provokes a cellular immune response, which is expressed as changes in interferon status, cytotoxic activity of natural killer cells, methylation processes, etc. The use of a holistic approach to treatment, a comdoibination of traditional therapy, antigen-specific vaccination and administration of immunomodulating agents seems relevant for patients with persistent high-risk oncogenic papilloma virus, as well as precancerous diseases and cervical cancer. The use of immunomodulators in the complex treatment of virus-associated diseases contributes to relief of symptoms and reduction of the recurrence rate.

Introduction. Vaginal infections of nonspecific etiology caused by microbiocenosis disorder is one of the leading aspects of gynecological morbidity in recent times. According to research statistics, the incidence of such disease varies from 30 to 80% among all inflammatory lower genital tract diseases in women. Aim of the study: to present the experience of preparation for ART in patients with chronic endometritis against the background of mixed forms of vaginal dysbiosis. Material and methods. The results of treatment with a drug containing metronidazole and miconazole nitrate (vaginal suppositories once a day at bedtime for 7 days) were studied in combination with natural micronized progesterone in 36 women with infertility caused by endometrial receptivity disorder due to chronic endometritis against the background of vaginal dysbiosis, in whom pre-implantation preparation with embryo transfer was carried out after the end of the therapy. The following were used: assessment of microbiota status of urogenital tract – PCR (femoflor-16), measurement of vaginal environment pH, Hay/Ison criteria, endometrial pipelle biopsy and endometrial immunohistochemical evaluation of endometrial receptivity (LIF, LIF-R) on the 3rd and 7th days after LH peak. Conclusion. The presented experience of complex local therapy of women diagnosed with “Infertility against the background of chronic endometritis and vaginal dysbiosis“ using a drug containing metronidazole and miconazole and natural micronized progesterone in the form of vaginal gel can be useful for practicing obstetricians-gynecologists and other interested specialists.

Empirical therapy of male infertility is used as a stand-alone type of treatment in idiopathic infertility, and in other situations can complement basic therapy. There are well-known pathogenetic methods of male infertility treatment applied in case of reproductive gland infection, hypogonadotropic hypogonadism, ejaculation disorders. However, the prospects of empirical treatment of male infertility are not fully clear. Combined antioxidant drugs are very popular, which include a wide range of similar substances. However, their molecules significantly differ from each other in structure, chemical properties and set of biological functions, therefore, there is a number of questions that deserve separate discussion regarding their compatibility with each other. Antioxidants such as various water-soluble and fat-soluble vitamins, coenzyme Q10, zinc and carnitines are widely used in its composition to reduce sperm damage caused by oxidative stress. They are widely available and inexpensive compared to other methods of treatment. Although there are no results of large randomized controlled trials yet, there is some evidence that taking oral antioxidoidants improves the basic parameters of sperm and increases the frequency of childbirth. There are many antioxidant supplements in different dosage forms, with different compositions and modes of use. In this article, we have analyzed the effect of the main antioxidant substances used on semen parameters, the need for their combined use and the role of these substances in the body.

Introduction: to investigate the possibility of using clindamycin and butaconazole in local therapy of moderate and severe dysbiosis in patients during the menopausal transition (early and late).

Materials and methods: 107 women were examined. They were divided into two groups depending on their complains: the patients of group 1 (49.5%) had an early transition to menopause (44.7 ± 2.3 years); the patients of group 2 (50.5%) corresponded to a late transition to menopause (49.1 ± 1.5 years). The complains were evaluated. The levels of hormones (FSH, AMH, Inhibin B, estradiol) were determined. A study of the vaginal biotope was conducted by PCR ‘Femoflor 8. Statistical studies were conducted in the environment of STATISTICA 10 package (Tibco, USA). The difference in average values was considered statistically significant for p<0.05. Results: vegetative-vascular disorders were typically for patient in group 2 and detected in 74.1%. Mucosal dryness was 5.2 times more common in patients 2 group, as was dyspareunia (5.5 times more often), dysuria (14 times more often), itching in the vagina (3.5 times more often), discomfort (3.4 times often). All patient in group 2, and 51% of patient in group 1 had moderate and severe dysbiosis on the background of hypoestrogenia.

Conclusion: The period of menopausal transition is characterized as a abnormalities of the vaginal biotope due to the activation of aerobes, anaerobes, and fungi of the genus Candida, and estrogen deficiency, that is more pronounced in patients with a late transition to menopause. Combined approach to the therapy these disorders allows to level out the clinical manifestation due to the consistent use of Clindacin B prolong and Ovipol Clio, but also improve the quality of life by individually selecting the duration estradiol therapy.

Introduction. To evaluate the effect of hormone replacement therapy on periodontal treatment outcomes complex, bone mineral density and articular syndrome in a group of postmenopausal women.

Materials and methods. We carried out an exploration of 32 postmenopausal women aged 50-59 years , with chronic periodontitis, postmenopausal osteoporosis, hand osteoarthritis. The control group (n=14) didn’t receive HRT (HRT–). The test group (n=18) –received HRT (HRT+).All subjects were examined by recording the following: plaque index (PI), sulcus bleeding index (SBI), periodontal pocket depth (PD), Dreiser`s index, VAS pain score. Measurements were recorded at the baseline, 1 month, 3 months, and 6 monthsю Results. The significant decline was revealed in all of the values (PI, SBI, PD) in HRT+ compare to HRT-. After 6, 12 months, in the periodontal area had been stabilized in the HRT+ group. 11.2% reduction was indicated in the lumbar spine and 8,15% reduction in the femoral neck within the HRTafter 1 year. The significant decrease was discovered in VAS pain score, Dreiser`s index, painful joints quantity in HRT+.

Conclusions: 12-week HRT was highly effective in periodontal treatment outcomes (significant decrease in PI, SBI, PD after 3 months). BMD of the femoral neck and lumbar spine is reduced within 1 year in patients with MHTcompared with MHT +.In the group of MHT +, compared with the group of MHTand baseline data, after 3 months there was a significant improvement in the number of painful joints, the level of pain, the Dreiser index, a positive effect persists until the end of the study.

Introduction. The number of women with multiple pregnancy is increasing worldwide, especially in countries with a high level of health care, where assisted reproductive technologies are widely used. According to foreign studies, one third of twins are born as a result of Assisted Reproductive Technologies (ART), so only an increase in multiple pregnancy can be predicted in the future. The main obstetric problem with these pregnancies is the problem of carrying.

Objective: To identify the predictors of preterm birth in patients with multiple pregnancy in order to improve monitoring and prophylactic measures among this cohort of women.

Material and methods: A retrospective controlled observational study, including 154 patients with multiple pregnancies was carried out. Logistic analysis was used to identify the predictors of preterm labour.

Results: The study showed that the predictors of preterm birth varied from one trimester to another. Based on the identified predictors, the predictive models for each trimester of pregnancy were compiled. Most of the identified predictors are related to obstetrical history. Risk groups formation, based on the identification of these predictors, is extremely important for qualified medical support. Prophylactic measures should be performed on the pre-conceptional stage. Pregnancy planning should be recommended only after treatment of chronic endometritis, followed by control of vaginal microflora and progesterone support. It is hardly possible to talk about the prevention of cervical insufficiency. However, cervical correction is an important factor for perinatal outcomes improving. The research suggests that the insertion of cervical pessary in women with multiple pregnancy and cervical insufficiency allows to prolong the gestational period for 7 weeks.

Conclusion: a comprehensive approach of management of women with multiple pregnancy based on the prognostic scales of preterm labour, allows to reduce the preterm birth rate.

Preventing infectious diseases is very important in obstetric and gynaecological practice. Vitamin D is a complex regulator of innate and adaptive immunity. It is known that lack of vitamin D reduces antibacterial and antiviral immunity, stimulates the development of pathologies associated with chronic systemic inflammation. Evidence from evidence-based medicine indicates the importance of using vitamin D preparations to support immunity. The results of fundamental and clinical studies have shown that chronic inflammation and congenital immunity disorders resulting from vitamin D deficiency significantly reduce the body’s resistance not only to tuberculosis, but also to viral hepatitis, acute respiratory infections, papillomavirus and herpesvirus. In addition to a pronounced antibacterial effect, vitamin D is also characterized by its antiviral action. By increasing the expression of interferon-alpha, cathecidine, defensin and antiviral microRNA, vitamin D activates various mechanisms of congenital antiviral immunity. Studies show the need to compensate for vitamin D deficiency for successful therapy of viral hepatitis, respiratory infections, human papillomavirus (HPV) and herpesvirus. In the present article the molecular fundamentals of antiviral action of vitamin D are sequentially considered, as well as the results of fundamental and clinical studies indicating the action of vitamin D against the viruses of hepatitis, herpes, RSV, Epstein-Barr, human papillomavirus, the possibility of using vitamin D in the treatment of these and other viral pathologies is considered. The authors analyzed data on the effect of vitamin D on immunity functions and antiviral protection of the human body.

The purpose and objectives of the study is to assess the effect of hyperhomocysteinemia on the first trimester of gestation in women with uterine myoma. Relevance. Biochemical and hormonal changes that occur in the myometrium and the body of a woman as a whole, without preventing the onset of pregnancy, can have a significant effect on the formation of the chorion and the clinical course of the gestational process, provoking complications such as miscarriage. Material and research methods. To achieve this goal, we examined 182 pregnant women, of which the main group was 98 pregnant women with a verified diagnosis of uterine fibroids, which took place before gestation, but did not prevent pregnancy. The comparison group included 84 pregnant women without anamnestic indications of gynecological pathology and signs of fetoplacental insufficiency. Results. We made an attempt to highlight the features of the content of homocysteine and thyroid hormones in pregnant women with uterine myoma and the influence of these indicators on the onset of gestation. Considering the results obtained, we indicate that pregnant women with uterine fibroids and without a tumor had significant differences in individual values. Conclusions. In women with benign tumors of the uterus that are pregnant, the most common conditions in the first trimester are mild anemia and genital tract bleeding. Half of the observed pregnant women with uterine myoma have hyperhomocysteinemia and, in some of them, subclinical hypothyroidism. This must be considered when preparing for the pregnancy of these women.

Background. Postpartum purulent-septic diseases are one of the topical issues of modern obstetrics due to high prevalence and absence of downward trend toward reduction in the disease incidence.

Objective: improve the management of high risk puerperas to prevent the development of purulent-septic complications in the postpartum period.

Materials and methods. The cohort prospective comparative study included 78 puerperas, who experienced spontaneous labour complicated by injuries to birth canals. The patients were divided into two groups according to the risk of developing purulentseptic complications and the management of patients. Group 1, control group, (n = 20) included the puerperas, who did not show any signs of inflammatory diseases of the genital tract during pregnancy. Group 2 included patients, who were diagnosed with various forms of vaginal dysbiosis based on the results of bacterioscopic and bacteriological examination of the genital tract. The group was further divided into two subgroups depending on the type of treatment. Subgroup 1 of Group 2 (n = 28) only received standard hygiene care, and subgroup 2 (n = 30) received standard hygiene procedures combined with vaginal irrigation using benzidamine hydrochloride solution (Tantum Rosa) for 3 days in the obstetric hospital.

Results. The study resulted in improving postpartum care of high-risk puerperas to prevent purulent-septic complications. Discussion The test results showed that the use of benzidamine hydrochloride (Tantum Rosa) in the postpartum period prevents the purulent-septic complications of puerperium, such as inflammation and disruption of perineal muscle sutures and endometritis, as well as relieves pain and discomfort, and improves the puerperas’ quality of life.

Conclusion: Based on the study results, we recommend the use of this drug in the early postpartum period to prevent purulentseptic complications in the high-risk groups.

Introduction. The article discusses the possibilities of comprehensive management for patients with Asherman’s syndrome.

Objective: to describe the experience in comprehensive management of patients with Asherman’s syndrome using an enzymatic proteolytic agent – bovgyaluronidase azoximer.

Material and methods. A total of 43 patients with Asherman’s syndrome were examined. The examination methods included transvaginal ultrasound (TVUS), hysteroscopy, intrauterine dissection of synechia, endometrial histopathological examination, IL-6, IL-10, VEGF-A and TGFβ1 test in cervical mucus. The treatment included hysteroscopy, dissection of intrauterine synechia and use of Longidaza I.M. at a dose of 3000 IU once every three days for the course – 5 injections followed up by 1 supposidoitory (3000 ME) intravaginally once every two days for the course – 15 applications) on the top of already administered cyclic estrogen gestagen therapy.

Results. A statistically significant reduction of anti-inflammatory index (AII) and TGFβ1/VEGF-A ratio in cervical mucus up to the test results of healthy women of reproductive age (controls) was observed in assessing changes in the local immunological status in patients with Asherman’s syndrome under pressure of azoximer bovgioluronidase therapy after 6 months of observation. AII – 0.68 (0.02) c.u. Group 1 against 0.65 (0.03) c.u. (in control), p = 0.87 and TGFβ1/VEGF-A – 1.8 (0.3) c.u. against 1.4 (0.2) c.u. accordingly, p = 0.84.

Сonclusions. Analysis of clinical efficacy of azoximer bovgyaluronidase in the comprehensive management of 21 women with second-grade intrauterine synechia showed recovery of menstrual cycle in 18/21 (85.7%) patients, relief of menstrual pain in 11/21 (52.3%) patients. 6/21 (28.5%) patients with infertility and 2/21 (9.5%) patients with miscarriage obtained spontaneous pregnancy 12 months after the therapy. All pregnancies ended in term births.