Introduction. Ectropion of the cervix (EC) is a condition when there is a cicatricial deformity of the uterine cervix (as a result of traumatic injuries) with visualization of the ectopic columnar epithelium on the vaginal part of it. The ectopia is currently classified as a variant of the normal histophysiological state of the cervix. This article discusses the features of the course and methods of treatment of complicated EC.

Objective of the study is: to develop and evaluate the effectiveness of a new method of complex treatment of CE.

Material and methods. In an open prospective study, 133 patients with CE (groups 1 and 2) and 56 healthy women (group 3) has taken part. In group 1 (n = 83), we have used a method for treating CE developed by us, which included two stages: stage I – elimination of microbial and viral pathogen in combination with immunomodulatory therapy, II – electrosurgical treatment (Leep biopsy) and treatment of the cervix with Galavit (100 mg of dry matter) dissolved in 5 ml of Miramistin (Patent for invention RU 2568768 C1). In group 2 (n = 50), surgical treatment of CE has been preceded by vaginal sanitation, empirical antibacterial and antiviral therapy. Diagnostic measures, in addition to standards, have included: determination of interleukins IL-1β, IL-6, IL-8, IL-10 in the discharge of the cervical canal, ultrasound diagnostics with Doppler measurements in the vessels of the central zone of the cervix. Statistica 7.0, SPSS 17 packages have been used for statistical processing.

Results and discussion. Before the start of treatment, patients in groups 1 and 2 have been found to have a combination of CE with cervicitis (100%), ASCUS cytological picture (more than 60%), abnormal colposcopic signs (100%), imbalance of the local immune system with a predominance of Th1 cytokines (the content of IL-8 increased 2.6 times; IL-1b – 13 times; IL-6 – 20 times, and IL-10 – in 1.7 times) against the background of increased vascularization and cervical perfusion. The reparative process after Leep biopsy in group 1 has ended by the end of 3 weeks in 65.6% of patients, in group 2 – in 25.5%, after 5 weeks – in 100% and 57.4%, respectively, after 8 – in group 2, 91.5%. The average period of epithelialization of a wound on the cervix in group 1 was 27.4 ± 4.3 days, in group 2 – 39.5 ± 5.6 days (p = 0.01). After 2 years, the recurrence of cervical pathology has been recorded only in group 2 (34.0%).

Conclusion. The use of the developed method of two-stage complex therapy for CE increases the effectiveness of treatment, prevents complications after Leep biopsy, accelerates epithelialization by 30.6% and avoids recurrence of the disease.

Varicocele is a common disease that occurs in 35–40% of men with primary infertility and in 80% of men with secondary infertility Disturbance of microcirculation in the testicles, which occurs during varicocele, lead to ischemia and hypoxia of the testicles, which provoke degenerative changes in all testicular cell populations. Retrograde blood flow from the testicular vein and the external spermatic vein into pampiniform venous plexus leads to an increase of hydrostatic pressure in the testicular vascular system and rise of temperature, and it also contributes to the development of sterile inflammation. Oxidative stress, nitrosative stress, and hypoxia are generally recognized elements of the pathogenesis of infertility associated with varicocele. It is known that when the supraphysiological level of reactive oxygen species in the ejaculate is reached, their concentration disrupts the structure and function of spermatozoa. Nitric oxide (NO) is involved in the regulation of body temperature, NO-dependent mechanisms may contribute to the increased scrotal temperature during varicocele. The physiological concentration of NO pro duced by testicular macrophages stimulates steroidogenesis in Leydig cells. However, in the presence of certain reactive oxygen species, NO can transform into peroxynitrite and other strong cytotoxic metabolites, which lead to dysregulation of testosterone synthesis involved in spermatogenesis. Also, manifestations of varicocele among infertile men have decreased expression levels of the testis-specific heat-shock protein, HSPA2, and abnormal methylation of sperm DNA. Therefore, the use of combined anti oxidant supplements as part of adjuvant therapy after surgical treatment or as an independent application in some clinical cases appears to be an adequate strategy to optimize fertility in patients with varicocele. In this review, we evaluated the importance of various antioxidants, such as vitamin E, folic acid, carnitine, inositol, arginine, acetylcysteine, zinc, selenium in spermatogenesis and their effect on reproductive function during varicocele.

Introduction. Comparative analysis of urinary and recombinant gonadotropins is ongoing to improve the efficiency of assisted reproductive technology programs. Particular interest focused on the identification of individual groups of patients with maximal efficacy of using certain ovarian stimulation drugs in an assisted reproductive technology program.

Objective. To review the application of Menopur Multidose 1200 IU for ovarian stimulation in assisted reproductive technology protocols with gonadotropin-releasing hormone agonists (GnRH) or gonadotropin-releasing hormone antagonists (GnRH antagonists) in the current clinical practice.

Materials and methods. The study retrospectively enrolled 4,080 women aged 20-43 years. Ovarian stimulation in the Assisted Reproductive Technology program was performed using the GnRH antagonist protocol in 65.8% of patients and the GnRH agonist protocol with Menopur Multidose 1200 IU with or without the additional Menopur 75 IU in 34.2% of women.

Results. Clinical and laboratory data of the patients, stimulated cycle parameters, characteristics of the embryological stage, and results of the assisted reproductive technology program were analyzed. The frequency of obtaining degenerated oocytes did not exceed 5%. The relative number of blastocysts of good quality was 59.9%, while for patients in the older age group, the figure was 54.6. The average pregnancy rate in patients in the “Menopur Multidose 1200 IU p/k” group was 39.3%, which corresponds to high-performance indicators of the assisted reproductive technology program.

Conclusions. Administration of highly purified human menopausal gonadotropin (hMG) (Menopur Multidose 1200 IU) to stimulate ovarian function in patients of different ages is accompanied by an adequate number of mature oocytes, good quality blastocysts, and satisfactory clinical pregnancy rates. Thus, highly purified human menopausal gonadotropin is not inferior to recombinant follicle-stimulating hormone(r-FSH) concerning the efficacy of assisted reproductive technology programs.

Prevention of unwanted pregnancies, abortions and their complications is one of the major problems of healthcare. The most effective method of unwanted pregnancies prevention is family planning with highly effective contraceptive methods. Currently number of unwanted pregnancies cases is still numerous. Problem of unwanted pregnancy cannot be solved completely with any method of contraception. Every fourth pregnancy in the world is considered as unplanned, more than half of them end in abortion, which can pose a threat to health of the patient. Overall, more than 90% of abortions are performed due to unwanted pregnancies. Emergency contraception continues to play an important role in family planning today. It is known that the effectiveness of emergency contraception decreases with the time after unprotected sex. Today a variety of emergency contraception methods exists, which allows individual approach to specific patient. The article presents the results of randomized clinical trials and meta-analyses evaluating all currently used methods of emergency contraception from the evidence-based point of view. The article also describes drugs specifics, features, and effects on the reproductive system.

Introduction. In the cohort prospective comparative study, the investigators examined the effectiveness of intraoperative administration of Antiadgesin and adjuvant therapy with Gynestril after laparoscopic-assisted myomectomy combined with temporary balloon occlusion of the internal iliac arteries and embolization of uterine arteries in the treatment of uterine fibroids.

Objective. To achieve stable remission of the disease, improve reproductive outcomes after myomectomy.

Materials and methods. 100 women who underwent organ-preserving treatment of uterine fibroids from January 1, 2015 to December 31, 2020 were enrolled in the study. The eligibility criteria were as follows: the age of 28–45 years (the mean age was 34 ± 4.5 years), organ-preserving treatment of uterine fibroids. The exclusion criteria from the study were as follows: the age of over 45 years; allergic reactions to mifepristone, Antiadgesin and contrast media; patients with contraindications for use of drugs, with aggravated medical history, with liver diseases, with endometrial hyperplastic processes (adenomyosis, endometrial hyperplasia).

Conclusions. It has been shown that the continuous use of Gynestril at a dose of 50 mg/day for 3 months after surgical treatment due to proliferating uterine fibroids led to the absence of disease-recurrences within two years after discontinuation of the drug, and the occurrence of a relapse in one patient three years after treatment. The use of Gynestril after embolization of the uterine arteries made it possible to statistically reduce the size of the node by 25% within 12 months, 50% after 24 months and 70% – after 36 months. (p <0.05). Intraoperative use of Antiadgesin made it possible to prevent adhesion and development of tubalperitoneal infertility.

Conclusion. The combination treatment of uterine fibroids, including myomectomy and drug therapy with Antiadgesin and Gynestril, made it possible to implement reproductive function in 73.3% of patients, moreover, 40% of patients had undergone a natural delivery

Introduction. Adenomyosis remains one of the significant challenges in modern gynecology and affects a large number of women of reproductive age. The clinical presentation of adenomyosis is variable, with severity of symptoms depending on the form of the disease. In case of the occurrence of severe pelvic pain, dysmenorrhea and dyspareunia, the disease disrupts social functions and leads to a decrease in the patient’s quality of life.

Aim. To study clinical and anamnestic features and patient’s quality of life with diffuse and nodular forms of adenomyosis.

Materials and methods. The study included 126 patients with various forms of adenomyosis (45 patients with nodular adenomyosis (NAM), 81 with stage III – IV DAM). The control group included 20 patients with tubo-peritoneal factor of infertility, without adenomyosis based on the ultrasound and hysteroscopy findings. All patients underwent a comprehensive examination, including general clinical, instrumental and laboratory tests. The study included a comparative analysis of the obtained data and determination of the clinical and anamnestic characteristics of the patients with stage III – IV DAM as compared with the patients with NAM. We also studied the quality of life of patients with NAM and DAM on the basis of a specialized questionnaire on the study of the quality of life of patients with endometriosis – Endometriosis Health Profile, ENR-5+6. Statistical analysis and data processing were conducted using Microsoft Excel (version 16), Statistica 10.0, StatPlus 7.3, GraphPad Prism 9 software. Data processing was performed in accordance with the guidelines for medical and biological research.

Results and discussion. As compared with patients with nodular adenomyosis, the patients with stage III-IV diffuse adenomyosis are characterized by an older age (42.1 (4.6) and 34.6 (6.2) years, respectively; p <0.001), have a high prevalence of somatic (96 and 77%, respectively; p < 0.05) and gynecological pathology (79 and 51%, respectively; p < 0.001) in past medical history, a higher frequency of intrauterine manipulations (hysteroscopy, separate diagnostic curettage) (73 and 42%, respectively; p < 0.001) and medical abortions (52 and 28%, respectively, p < 0.001). Complaints of heavy menstruation, bloody vaginal discharge between periods, and intestinal symptoms had a special place among the complaints of such patients. Moderate to severe anemia, as a consequence of heavy menstrual bleeding, was also a frequent concomitant pathology.

Conclusions. Stage III-IV DAM is characterized by a more severe course and marked symptoms as compared with NAM, and significantly affects the patient’s quality of life.

Vulvovaginal candidiasis (VVC) is considered as the second most common cause of vaginitis after bacterial vaginosis. About three quarters of women of reproductive age have a history of at least one episode of VVC, and about a half of women have two or more episodes. Candida albicans is responsible for85% to 90% of vulvovaginal candidiasis. There are uncomplicated and complicated forms of VVC. Uncomplicated forms are not severe cases caused by C. albicans. Complicated forms are cases caused by other Candida species, severe cases, cases that develop during pregnancy or associated with other diseases such as diabetes mellitus or immunosuppressive conditions. Reccurent cases are also complicated ones. Therapeutic schemes should depend on the form of the VVC. Short-term topical therapy or a single oral dose are effective in 90% of uncomplicated cases. Complicated forms of VVC require longer treatment. Oral fluconazole can be administered three times with a break of 72 hours. Topical azoles can be administered daily for at least 1 week. So, sertaconazole in the form of suppositories is used once intravaginally. The data on the use of probiotics in the treatment of VVC today are contradictory and heterogeneous. Treatment of VVC during pregnancy, especially in the first trimester, may be associated with adverse perinatal outcomes. On the other hand, during pregnancy, VVC can be more severe than in non-pregnant women, especially in the second half of pregnancy. In addition, the risk of transmission to a newborn is about 50%. Thus, the identification and treatment of VVC is one of the important tasks in pregnancy planning, including assisted reproduction.

Introduction. Despite the availability of general principles and regimens for ovarian stimulation on the assisted reproductive technology (ART) programs, an individual situational modification is required in each specific case.

Objective. To optimize the ovarian stimulation protocols on the ART program based on the clinical and medical history records of the married couple.

Materials and methods.The clinical and medical history records, as well as the stimulation cycle parameters of 60 married couples were analysed. The married couples enrolled in this study were diagnosed with infertility caused by tubo-peritoneal (44 married couples), male (5 married couples), combined factor (6 married couples), as well as external genital endometriosis combined with a male factor (3 married couples), and tubo-peritoneal factor (2 married couples). All married couples underwent IVF/ICSI procedures under the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol and ovarian stimulation on day 2 or 3 of the menstrual cycle.

Results. All married couples were divided into two groups: 38 couples with a negative implantation result and 20 married couples with positive implantation results. The surgical removal of fallopian tubes has been shown to be inversely correlated with the duration of infertility. The use of hCG positively correlates to the ratio of mature oocytes and oocyte-cumulus complexes (OCC) and the onset of pregnancy. A reduced percentage of morphologically healthy sperm with an overall high concentration of sperm in the ejaculate can be interpreted as fertile sperm.

Conclusions. During ovarian stimulation on the ART program, special attention should be paid to the duration of stimulation, the types of interventions for triggering final oocyte maturation and the total gonadotropin dose. A differentiated approach to conducting the surgical removal of fallopian tubes is required. The reduced percentage of morphologically healthy sperm with an overall high concentration of sperm in the ejaculate serves as a favourable prognostic factor for the outcome of ART programs.

Introduction. About 10–20% of patients among women of reproductive age suffer from signs and symptoms of androgen excess in hyperandrogenism. Its skin symptoms may include hirsutism, acne, seborrhea and alopecia.

Aim. To assess the effect of cyproterone acetate on skin symptoms of hyperandrogenism and improvement in the patients’ quality of life after treatment.

Materials and methods. The study included 120 patients with skin symptoms of hyperandrogenism. The patients ranged in age from 18 to 35 years. The inclusion criteria were the main complaints of the patients as follows: acne, hirsutism and alopecia. The patients underwent a comprehensive clinical and laboratory examination. The drug of choice for the treatment of androgendependent dermatopathies was cyproterone acetate at a dose of 50–100 mg daily.

Results and discussion. All patients were divided into three groups: 44 (37%) patients with hirsutism, 55 (53%) with acne, 12 (10%) with alopecia. Moreover, 32 (27%) patients had a mix of symptoms at the same time. Such patients were assigned to one of the groups depending on the predominant complaint. All patients were prescribed cyproterone acetate at a dose of 50-100 mg once daily, depending on the severity of symptoms from day 1 to day 10 of the menstrual cycle, and 54 (52%) patients were prescribed cyproterone acetate 20 mg and ethinyl estradiol 35 mg from day 1 to day 21 of the menstrual cycle. The study showed stabilization of the psychoemotional state, relief of anxiety, depressive disorders, enhancement of self-esteem and sociability, and improvement of the quality of life in its various manifestations in the majority of patients after the treatment.

Сonclusion. When assessed using the dermatology life quality index questionnaires, all patients reported the stabilization of the psychoemotional state and the improvement in the quality of life after the treatment. The anxiety and depressive disorders decreased in 109 (91%) patients, which favourably influenced various areas of quality of life, enhanced self-esteem and sociability with a positive effect on personal relationships.

Review article is devoted to one of the most common polygenic endocrinopathies in women of reproductive age, polycystic ovarian syndrome (PCOS). We review the current criteria used to make a correct diagnosis based on four phenotypes of PCOS: Frank (phenotype A) – biochemical and/or clinical hyperandrogenism, oligo-/anovulation, polycystic ovarian morphology according to ultrasound; anovulatory (phenotype B) – oligo-/anovulation, biochemical and/or clinical hyperandrogenism; ovulatory (phenotype C) – biochemical and/or clinical hyperandrogenism, polycystic ovarian morphology according to ultrasound; non-androgenic (phenotype D) – oligo-/anovulation, polycystic ovarian morphology according to ultrasound. This article presents the main theories of PCOS pathogenesis: peripheral, central, insulin, genetic, and also considers epigenetic factors. PCOS is a multifactorial disease in which genes are responsible for the mechanisms of the process, and environmental factors through epigenetics affect the genetic material. PCOS phenotypes play an important role in clinical practice, as they allow an individualised approach to the selection of therapy in each case, taking into account the pathogenesis of the disease and predicting its course in the future. The main therapeutic options for treating patients with PCOS, taking into account the multifactorial nature of the disease and the patient's interest in pregnancy, are reviewed. The article presents modern methods for the correction of hyperandrogenism and anovulation, with special emphasis on the need for progesterone therapy.

The negative effects of hypovitaminosis D3 and vitamin D3 deficiency in 80% of Russians make eliminating vitamin D deficiency an issue of state concern. Hundreds of effective clinical studies showed realistic opportunities of vitamin D3 to help patients with disorders of carbohydrate and lipid metabolism, high levels of nonspecific inflammation, tuberculosis, and women with a higher risk of complications and pregnancy losses. Vitamin D3 supplements are essential for the prevention and treatment of a wide range of “bone” and “extraosseous” diseases. One of the most important aspects of the clinical uses of vitamin D3 is the dosage and dosage regimen of the vitamin. This paper presents the results of a “mega-analysis” of 3965 clinical studies of vitamin D3 in terms of the effectiveness of different dosages in achieving different clinical outcomes. It was shown that dosages of 2000 IU/day and 4000 IU/day correspond to the peak values of the effectiveness index, regardless of the diagnoses studied (mega-analysis of 420 randomized trials). Some effectiveness in the treatment of rickets, gestational diabetes, calcium metabolism disorders, disorders of bone density and structure, diseases of the musculoskeletal system and connective tissue can be achieved using weekly dosages of 50,000 IU/week (mega-analysis of 196 studies). It has been shown that dosages of 100,000-1,000,000 IU, intended for a single dose once a month, are almost always found only among studies with a negative result (mega-analysis of 368 studies).

Urinary tract infections during pregnancy are associated with severe complications. Earlier initiation of antibiotic treatment for acute uncomplicated cystitis, reduces the various complications.

Objective. To assess the effectiveness of fosfomycin in the treatment of acute uncomplicated cystitis during II and III trimester of pregnancy.

Material and methods. The study included 74 pregnant women who had acute uncomplicated cystitis in II or III trimesters. All patients received fosfomycin trometamol 3.754 g (equivalent to 3 g fosfomycin) as antimicrobial therapy for acute uncomplicated cystitis. The drug was prescribed to 24 pregnant women in the II, and 50 in the III trimester of pregnancy.

Results. After treatment with fosfomycin signs of acute cystitis gone in all patients. At the same time, regression of clinical symptoms was noted during the next days after therapy in 95.9% (n = 71) of cases. Repeated microbiological test of the middle portion of urine was performed 7 days after the end of antibiotic therapy. In 94.6% (n = 70) cases, total elimination of the pathogen was achieved. In 5.4% (n = 4) cases, there was a significant decrease of colonization Follow-up for three months showed the absence of recurrence of acute cystitis in all pregnant women who were included in the study.

Conclusion. Fosfomycin is a highly effective drug in the treatment of uncomplicated cystitis during pregnancy.

Introduction. We assessed the features of kidney injury in patients with different types of TMA during pregnancy, taking into consideration the fact that the acute kidney injury (AKI) that occurs during pregnancy or in the early postpartum period is main- ly caused by various types of thrombotic microangiopathies (TMA), and AKI itself is a serious obstetric complication with the risk of serious complications and mortality for both mother and fetus.

Objective of the study. To study the features of nephropathy in different types of pregnancy-associated TMA.

Materials and methods. The study included 313 pregnant women, women in childbirth and puerperas, of which 71 women had atypical hemolytic uremic syndrome (aHUS), 124 – HELLP syndrome, 70 – varying degrees of severity of PE, a group of patients with more rare causes of TMA was also identified: TTP, CAPS and sepsis (13 patients) and 45 patients for the control group. We assessed and compared the main clinical, laboratory and instrumental data, and assessed the outcome of labour. Also, histological examination of the kidneys was performed in five patients with aHUS.

Results and discussion. The results of the study have shown that the most severe manifestations of TMA in the form of target organ injury and nephropathy are usually occur in patients with aHUS, where all women developed AKI, in some cases with the formation of chronic kidney disease. In the HELLP syndrome group, AKI was recorded in 39%, but renal function quickly restored. It was found that the very fact of the presence of AKI points to a more unfavourable prognosis not only for the patients themselves, but also for the child, being the main risk factor for perinatal death. The findings of urinary sediment tests and morphological evaluation indicate that the resulting ischemia of the renal tissue in cases of aHUS, HELLP syndrome and other types of TMA can lead to tubular necrosis as compared with PE. Our results suggest that it is AKI in HELLP syndrome that is the main risk factor for perinatal death. Alas, this relationship is difficult to trace in patients with aHUS, as all of them had AKI.

Conclusions. Timely recognition of the AKI phenomenon in all cases of obstetric TMA can reduce the risks for both mother and fetus. Both the prognosis for mother and the prognosis for child depend on AKI, and timely therapy can lead to a regression of AKI phenomena and the complete restoration of renal function.

Timely diagnosis of chromosomal aneuploidies plays an important role in determining the proper approach to the management of pregnancy. This article outlines the current ideas on the likelihood of occurrence of obstetric pathology, depending on the number of cells with genetic aberration, especially in the placenta. Such obstetric complications include fetal growth retardation, premature birth, and some forms of preeclampsia. The article describes the prenatal examination techniques, which help obtain timely information about the development of the fetus and predict pregnancy complications, more specifically, non-invasive prenatal DNA screening as a new technique with its advantages and limitations, based on the analysis of DNA of placental origin. It also highlights other latest diagnostic tools that allow to get more accurate information about placental mosaicism and the development of pathology. We have reviewed publications over the past 10 years, which are devoted to the factors responsible for the formation of placental mosaicism, the prenatal diagnostic procedures required for an accurate diagnosis, and the likelihood of obstetric pathology in case of prolonged pregnancy complicated by genetic aberrations. Foreign studies confirm the direct dependence of the likelihood of obstetric pathology on the number of cells with genetic aber ration. In accordance with the above study results, it would be only right to note that placental insufficiency can be observed in any case of genetic aberration, especially if a large volume of cells is involved in the pathological process at an early stage of differentiation. In addition, the article discusses the issue of need of thorough prenatal diagnosis to prevent the development of pregnancy pathology, including the use of the latest technologies and minimizing invasive methods.

Introduction. The novel coronavirus pandemic makes the issue of iron deficiency in pregnancy even more urgent and forces multidisciplinary clinicians to search for modern ways to correct disorders caused by this infection.

Objective. To assess the features of the course of post-covid anemia associated with combination therapy, as well as the effect of therapy on the dental health status in pregnant women.

Materials and methods. 30 pregnant women (treatment group 1) in the third trimester who had coronavirus infection with mild IDA during gestation were enrolled in the prospective study. Comparison group 2: included 15 patients with mild IDA who did not have coronavirus infection during gestation. Control group 3: included 15 conditionally healthy pregnant women without IDA who did not have a novel coronavirus infection during gestation.

Results. Pregnant women who had COVID-19 during gestation were significantly more likely to suffer from gum bleeding, angular cheilitis, oral erosive and ulcerative lesions. Gum bleeding was significantly more common in pregnant women with IDA against the background of coronavirus infection, than in the women in the comparison and control groups (SBI index, p < 0.05). The decrease in the normal microflora suggests the presence of dysbiotic changes in all pregnant women against the background of IDA, however, the patients after the COVID-19 infection had the most significant changes in it.

Conclusions. The novel coronavirus infection, which the women had during gestation, aggravates the course of IDA, reduces the quality of life of patients with characteristic complaints (gum bleeding, angular cheilitis, oral erosive and ulcerative lesions), leads to dysbiotic oral microbiome changes. The management of this group of patients requires a systemic correction of the microflora balance, the introduction of individual oral hygiene regimens and adequate treatment of IDA using high-technology medicinal products

Striae may form on the skin due to a number of factors: rapid weight gain, muscle hypertrophy, endocrinopathies, breast enlargement, as a side effect of long-term topical use of strong corticosteroids. However, in some rare circumstances, striae can develop as a complication due to the use of tissue expanders. This cosmetic defect develops most often on the skin of the thighs, abdomen, mammary glands in women and the shoulders in men. Striae of pregnancy are a common cosmetic skin defect. The development of striae is associated with stretching and rupture of connective tissue in susceptible individuals against the background of influence of genetic and hormonal factors. The appearance of striae gravidarum does not have a significant effect on the health of patients, however, a cosmetic defect caused by the appearance of striae can generate psychoemotional (psychoemotional) stress and lead to a decrease in quality of life. The striae development occurs in certain stages. The initial period of striae development – red (immature) striae – is characterized by the absence of changes in the epidermis and signs of inflammation in the dermis. The appearance of white (mature) striae is accompanied by the architectural distortion of elastic fibre net and changes in the viscoelastic properties of the affected skin, which becomes much less elastic. The correction of striae requires topical treatment that help moisturize and soften the skin, stimulate the processes of collagen production, as well as physiotherapy techniques. However, many of them have contraindications for use during pregnancy. The article discusses the issues of the use of cosmetic products that can be used during pregnancy.

Introduction. Iodine deficiency remains an urgent challenge for the Russian Federation. Pregnant women should receive prophylactic potassium iodide supplements at a dose of 200–250 mcg per day. To monitor the severity of iodine deficiency in the regions and the efficacy of prenatal iodine prophylaxis, it is prudent to use the neonatal hyperthyrotropinemia rate for newborns (thyroidstimulating hormone level is higher than 5 μIU/L) based on the results of congenital hypothyroidism screening.

Objective. To assess the changes in the severity of iodine deficiency and the efficacy of iodine prophylaxis in pregnant women and newborns in the Saratov region based on the incidence of neonatal hyperthyrotropinemia over the past 25 years.

Materials and methods. The incidence of neonatal hyperthyrotropinemia in newborns in the Saratov region for the period of 1996–2000 and 2015–2020 was analysed. In total, 229,625 children were examined.

Results and discussion. In 1996–2000, neonatal hyperthyrotropinemia was detected in 37.4% of newborns, which was evidence of the presence of moderate iodine deficiency in the region. In 2015–2020, the incidence of neonatal hyperthyrotropinemia decreased by 5.42 times to 6.9% (p < 0.0001) against the background of group iodine prophylaxis in pregnant women, but remained higher than the World Health Organization targets for iodine-rich regions (<3%) suggesting the preservation of mild iodine deficiency in pregnant women and newborns in the Saratov region.

Conclusions. Despite the obligatory doctor’s prescription of prenatal group iodine prophylaxis, there is still iodine insufficiency in pregnant women and newborns in the Saratov region, which requires further improvement of the regional iodine deficiency eradication action system in the risk groups. However, significant advances in the fight against iodine deficiency in the nutrition of the Russian population can only be achieved after the adoption of the federal law on universal salt iodization.

A tendency towards growing life expectancy in old age can be clearly observed in most countries of the world over the past number of decades. This tendency is also seen in our country. Despite the fact that people started living longer, which would seem to be a good indicator of the country’s socio-economic development, the doctors have encountered a rather difficult challenge to overcome. The question at issue is that health specialists are faced with many somatic diseases due to the fact that people started living longer. When life expectancy was much less, many of them have never encountered such a volume of diseases. Today, the share of the elderly in the population has significantly increased and they live longer, which, accordingly, has an impact on the number of nosological units in the clinical practice of almost any health specialist. This article is focused on the issue of non-decreasing incidence of urinary tract diseases; in particular, the challenges of bladder stone disease (BSD) are considered. According to the latest data, the disease prevalence does not tend to decrease. Moreover, the incidence of BSD in women has increased significantly, although this pathological condition is more typical for men. In light of the fact that female patients spend about a third of their lives in the postmenopausal period, it is worth paying special attention to some features of the woman’s body functioning during this time period due to the likelihood of the formation of an inflammatory process, which often mediates the development of the BSD. Older female patients are often concerned about inflammatory bladder diseases, which can lead to the development of BSD by ascending infection in the future. Therefore, it is crucially important to know what therapeutic capabilities doctors have today to effectively fight the BSD.

Introduction. Modern gynecological endocrinology widely discusses various disorders accompanying the onset of menopause. Metabolic disorders are one of the leading risk factors for the development of ischemic heart disease and vascular dystonia in menopausal women. That is why the drugs prescribed as part of menopausal hormone therapy are contraindicated for patients with severe metabolic disorders and predisposition to thrombosis. Women with a normal body mass index may develop the menopausal metabolic syndrome, since its presentations largely depend on the total body composition and the specific gravity of visceral adipose tissue.

Aim. To assess the patterns of clinical presentation of menopause in women with metabolic menopausal syndrome.

Materials and methods. In the furtherance of that aim, we examined 184 women who were in menopause 1 to 5 years at the age of 52 to 57 years (average age 54.2 ± 0.5 years). Of these, 87 were diagnosed with metabolic syndrome – they were included in the main group. The comparison group included 97 menopausal women without metabolic disorders.

Results and discussion. We assessed the severity of clinical presentations and the total body composition of the patients in the selected groups. It has been established that the body mass index cannot serve as a criterion for evaluation of metabolic processes, despite the sufficient simplicity of its computation.

Conclusions. The authentic view of the risks of metabolic disorders in menopausal women requires the study of total body composition.

The review article presents data on the prevalence of candidiasis of various localization against the history of coronavirus infection (COVID-19). The predisposing factors for the development and recurrence of candidiasis in patients after therapy for coronavirus infection have been analysed. Candida is one of the most common pathogens in intensive care units (ICUs), affecting 6 to 10% of patients, and some studies have reported an increasing trend in the prevalence of candidemia. The literature data that we analysed showed that the most common types of fungal infection among patients with a severe course of COVID-19 were C. albicans, then C. auris, C. glabrata, C. parapsilosis, C. tropicalis, S. cerevisiae, C. krusei and Rhodotorula spp. Candida non-albicans species, in particular C. glabrata, C. auris, were the most common causes of death. The previous treatment regimens for patients with COVID-19 included antibiotics, but at present time corticosteroids are more often used, which have an immunosuppressive effect and, accordingly, predispose to the development of candidiasis. The epithelial injury caused by SARS-CoV-2 also enables Candida to attach to the basement membrane, subsequently triggering the development of mucosal candidiasis. As the systemic and local candidiasis are conditioned by common immune mechanisms that are affected by coronavirus infection, vulvovaginal candidiasis (VVC) may recur during COVID-19 therapy. The timely diagnosis and treatment of fungal infections in patients who underwent COVID-19 are crucial for achieving a positive clinical outcome. The article provides an algorithm for the management of patients with recurrent VVC, the principles of action of antifungal drugs, their acceptability and efficacy.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) was declared the cause of a global pandemic in early 2020. Patients with COVID-19 are at high risk for thrombotic occlusions of the arteries and veins. There are many ways that explain the high risk of thrombosis in COVID-19, they are conditionally divided into two main categories: mechanisms in which the renin-angiotensinaldosterone system is involved and mechanisms that affect the regulation of the immune response. It is assumed that the uncomplicated course of the disease is characterized by endothelial dysfunction, but if the process progresses with a pronounced immune response, plasma coagulation factors may also be involved, which significantly increases the risks of thromboembolic complications. The use of combined hormonal contraception (CHC) in the current conditions raises a number of concerns. According to some researchers, disorders of the hemostasis system observed in patients with COVID-19 may worsen while taking CHC and increase the risk of thromboembolic complications, which is especially important in severe disease with prolonged immobilization. However, with the use of CHC, the increase in thrombotic risks is explained primarily by changes in the plasma component of the hemostasis sys tem. At first glance, the recommendations to stop hormone therapy with confirmed COVID-19 seem logical, but they are based only on the procoagulant activity of estrogens, and not on real evidence. In patients with COVID-19, the increase in coagulation is associ ated with massive damage to the vascular endothelium (the so-called «external» coagulation pathway) and the immune response, and not with a primary increase in the level of coagulation factors per se. At the same time, stopping the intake of estrogens deprives the patient of their important protective effect. Thus, it became necessary to develop clinical guidelines for the management of women using contraception in the context of the COVID-19 pandemic.

Introduction. In the research literature, there have been recorded instances of imbalance of interleukins and tumour necrosis factors in the cervix tissues, endocervical mucus, suggestive of the potential feasibility of the use of immunomodulatory therapy.

Purpose of the study. To assess the effectiveness of the use of the domestic drug allokin-alpha in the treatment of high-risk HPV infection (HPV) in patients of reproductive age, without elimination of the virus within more than 6–12 months and planning pregnancy.

Materials and methods. The study included 60 patients of reproductive age with chronic HPV carriage – BP infection. They are represented in the study by two groups: 1st: 30 people in whose therapy allokin-alpha was not used (control group); and 30 patients without HPV BPV elimination in terms of more than 6–12 months, planning pregnancy and taking the domestic cytokiton-like immunomodulator allokin-alpha.

Results. Spontaneous pregnancy occurred in 2/30 (6.7%) in the group without immunomodulator and in 9/30 patients in the group with allokin-alpha (30%) cases (c² = 5.45; p = 0.02; OR = 6.0 [1.17–30.72])

Conclusion. The sustained virological response that we have achieved indicates the advisability of the use of allokin-alpha, a domestic immunomodulator of natural origin, in patients with high-risk chronic HPV infection and reproductive planning.

Introduction. Infectious inflammatory and dysbiotic diseases of the vagina represent a major concern facing obstetric and gynecological science. Individually, the two most common specific diseases can be distinguished, namely: bacterial vaginosis (BV) and nonspecific vaginitis (NV). The therapeutic strategy for these diseases requires a word of clarification and adjustment.

Objective. To conduct a comparative analysis of treatment with the combination drug Orcepol WM (ciprofloxacin (500 mg) and ornidazole (500 mg)) and a combination of monopreparations in a dosage form similar to Orcepol WM.

Materials and methods. As a comparison object, we used the method of simultaneous administration by patients of tablet forms of ciprofloxacin and ornidazole as mono-preparations in a dosage of 500 mg similar to Orcepol. The study included 64 patients with diagnoses of “bacterial vaginosis” or “nonspecific vaginitis” or "decompensated mixed vaginal dysbiosis". The average age of the patients was 35.34 ± 5.95 years. The patients were divided into two groups: group 1 (n = 32) received the combination drug Orcepol WM, group 2 (n = 32) received ciprofloxacin and ornidazole with two mono-preparations. The drugs were prescribed as a five-day course, two times a day. The patients were followed up by a doctor during two visits and one remote interview on day 30–45 after the end of treatment (visit 2).

Results. In both groups, all patients received a full course of antibacterial therapy. There were no adverse drug reactions. In both groups, there was an improvement in clinical symptoms from the first to the second visit: discomfort, itching, burning, dyspareunia, hyperemia of the mucous membrane against the background of normalization of laboratory findings of the vaginal microbiocenosis condition. At the same time, the best results were higher in group 1. Manifestation of mycotic vaginitis with the development of strong clinical symptomatology on days 3 and 4 of treatment respectively were recorded in 4 (12.5%) patients from group 1 and 7 (21.9%) from group 2. The results of comparative observation showed that the number of relapses after the end of therapy were the same in group 1 (8 out of 32 patients, 25%) and in group 2 (9 out of 32 patients, 28%). The relapse occurred on average day 12 and 17 after the end of therapy, respectively.

Сonclusion. Thus, the use of Orcepol WM showed a greater therapeutic efficacy as compared to the use of tablet forms of ciprofloxacin and ornidazole in similar dosages as a single-drug administration, which can be explained by a stronger patients' adherence to the treatment.

Introduction. Cervical cancer holds one of the top positions in the oncological diseases ranking among the female population in the presence of iodine deficiency in the territory of the Republic of Bashkortostan. It's commonly believed that it is caused by the development of cervical intraepithelial neoplasia (CIN) associated with highly oncogenic strains of the human papillomavirus (HPV). The article pays special attention to the risk factors for the development of precancerous and cancerous diseases of the cervix and their timely treatment.

The aim of the study was to improve the diagnosis and therapy of HPV-associated CIN in the presence of iodine deficiency in the Republic of Bashkortostan.

Materials and methods. 256 women aged between 21 and 45 years with identified HPV-associated CIN I were enrolled in our study. The first stage of treatment known as preoperative was carried out in the outpatient setting. At stage 2, the patients were offered a radio-wave surgery treatment of the cervix.

Results and discussion. The video colposcope analysis showed that the average time of epithelialization of the cervix after exposure to the destruction depended on the age and duration of the disease. For instance, complete epithelialization of the cervix in the group of patients aged between 21 to 38 years was reported in 72% of cases by Day 40, and in 62% of cases in the group of 39-45 years old on Day 40. The complete elimination of the virus was observed in 236 patients out of 256 cases (92%) 70 days after the end of therapy.

Сonclusion. The study proves the effectiveness of the combination treatment of patients with HPV-associated CIN.

The article presents a systematic review of the results of modern clinical studies devoted to the problem of the microbiome and transcriptome in women with cervical intraepithelial neoplasia (CIN). Moderate to severe CIN (CIN II – III) can precede the development of cervical cancer (CC) by several years or even decades. Cervical cancer (CC) is an important global health problem. There is a year-on-year increase in the prevalence of CC. Currently, there are many known risk factors that contribute to the development of CIN and cervical cancer. However, the vaginal and cervical microbiome play an important role in the development and progression of CIN and CC, according to some authors. Thus, the timely detection and treatment of cervical intraepithelial lesion-associated genital infections is now especially important. From these point of view, bacterial vaginosis (BV) is considered an acute problem in gynecological practice, which affects the incidence of precancerous conditions of the cervix. The results of the studies have shown the importance of detailed analysis of the vaginal microbial community, which was performed by the method of next generation sequencing (NGS). These studies were conducted using the NGS method based on the analysis of bacterial 16S rRNA genes, which has a high diagnostic accuracy and allows to determine the verity of the microbial landscape. The study of the transcriptome in women with CIN showed a change in many microRNA molecules, which can become markers of the CIN and cervical cancer upon further study. The introduction of the NGS method into the laboratory diagnostics complex will improve the diagnosis and timely prevent the progression of CIN to cervical cancer.

The study of the microbiome of the vaginal biotope and cervical canal will allow to identify the groups of patients at high risk for the progression of precancerous lesions of the cervix and cervical cancer. Transcriptome studies have shown changes in many microRNA molecules (SALL4, FOXO1, HBD-1, HBD-2, HBD-3, LL37, psoriasin and IL-8, etc.) in women with CIN and cervical cancer.