The basic principle of differential diagnosis of different types of menorrhagia is to eliminate organic causes of bleeding, i.e. gynecological and extragenital. Treatment of menorrhagia is conducted in accordance with the etiology, degree of blood loss, the general state of the patient and aimed at correcting the identified organic pathology or restore normal menstrual cycle.

The article presents a clinical observation of treatment of massive obstetric bleeding in pregnant (gestational age 35 weeks) with placenta and accreta using recombinant activated factor  VII coagulation – Coagil-VII (Russia, “Generium”). In operation: laparotomy, caesarean section in the lower uterine segment transverse incision, ligation of the internal iliac arteries, metroplasty, tubal ligation for Genter, coagulopathic massive bleeding developed. Transfusion of FFP, autoerythrocytes, infusion of tranexam, crystalloid and colloid solutions were made. For the haemostatic effect rFVIIa Coagil-VII was introduced at a dose of 4.8 mg (70 mkg/kg) intravenous bolus. Within 15 minutes after bolus administration of the rFVIIa observed rapid and marked reduction in the rate of bleeding and volume in the operative field. This prevented the removal of the uterus and finish the metroplasty operation in favorable conditions. The analysis of the clinical observation indicates a high hemostatic effect of the Coagil-VII in treatment of the coagulopathic massive bleeding in pregnant women with placenta previa and accreta.

One of the first places in the structure of diseases of the female sexual organs is taken by bacterial vaginosis, which, by the literature data, is diagnosed in 30-57%  of women of the reproductive age [1, 2]. Bacterial vaginosis is an infectious noninflammatory syndrome characterized by a sharp reduction or lack of lactoflora and its replacement by polymicrobial associations of anaerobes and Gardnerella vaginalis, concentration of which achieves 109–1011 CFU/ml of vaginal discharge [3–5].

Adequate micronutrient intake during pregnancy or periconceptional period is essential for physiological ongoing pregnancy and normal fetal development. Number of authors reported efficacy of vitamin mineral complexes in reducing the risks of pregnancy complications, fetal malformations and adverse long-term outcomes. This manuscript represents a detailed review of the latest data on the role of micronutrients in prophylaxis of fetal congenital abnormalities  and pregnancy complications. Moreover, outcomes of micronutrient deficiency and the way of its replacement described, as well as the significance of epigenetic changes in fetal programming underlying a variety of adulthood diseases and determining child’s and its offspring’s wellbeing.

Polyetiologicity of placental insufficiency and formation of the intrauterine growth restriction require permanent improvement of approaches to therapy. Magnesium deficit leads to placenta metabolism disturbance, formation of stable psychoemotional distress. Application of magnesium drugs in a complex therapy of placental insufficiency allows in a majority of observations (85%) normalization of hemodynamic values in the system “mother-placenta – fetus”. The problem of antenatal neuroprotection of the fetal brain is an urgent and complex problem of modern obstetrics, which requires performance of further studies.

Peculiarities of the course of the papilloma viral infection in pregnancy are studied insufficiently. There is no generally accepted practice of patient maintenance. The aim of the study is to study possibilities of pharmaceutical correction of the papilloma viral infection (PVI) affected pregnant women. Various types of human papilloma virus are identified in 137 patients by polymerase chain reaction method. The immune system correction and therapy of sexually transmitted diseases  was administered to 33 women. 31  women didn’t receive  the  immune system  correction of therapy of sexually  transmitted diseases.  Spiramycyin, natamycyin, bifidumbacterin, tergynan, inferferon alpha2b + taurin were used for therapy. In addition to clinical and bacteriological study methods extended uterine colposcopy and cytologic methods of cervical smear were used.

The obtained results allowed drawing a conclusion that the sexually transmitted diseases drug therapy and the immune system correction, improving the colposcopic pattern and quality of cytologic smears optimizing the course of pregnancy; the sexually transmitted disease therapy is less effective than simultaneous sexually transmitted disease therapy and immune system correction.

The article analyzes possibilities of hypoferric anemia in patients with abnormal uterine hemorrhages. Pathogenetic mechanisms of iron carboxymaltosate in therapy of this pathology are described. A clinical observation of a girl of a growing age with hypoferric anemia is presented and its clinical effectiveness is proved.

The article describes the basic principles of correction and prevention of subclinical forms of placental insufficiency in patients with anamnestic  risk factors for the development of this pathology. Pathogenetic substantiation of administration of antiplatelet and angioprotective therapy during pregnancy in risk group patients is provided. It is given to discuss the possibilities of early detection of risk factors and prevention of clinical manifestations.

The article provides data on the composition, mechanism of action, side effects and additional non-contraceptive possibilities of modern peroral hormonal contraceptives (PHC). The universal approach to prescription of HCs is justified from the position of the similarity of their contraceptive action, safety portfolio and frequency of side effects. Examples of HC use are shown taking into account individual peculiarities and desires of the woman on the basis of their additional non-contraceptive properties.

Cytomegalia is a highly prevalent infection. The share of seropositive persons among the adult population of our country is 73–98%. According to the data provided by the Federal Service for Surveillance of Consumer Rights of Russia in the State Report “On Sanitary Epidemiological Situation in the Russian Federation in 2010” the incidence rate in 2010  has grown as compared to 2009  by 29  infectious and 7 parasitary diseases, in particular, this concerns cytomegaloviral infection – by 30.5% (only trichinellosis achieved the greater value (36.6%) and measles received a similar value – 29%).

The article is orientated at a wide range of specialists engaged in pregnancy and infancy problems: obstetrician-gynecologists, neonatologists, pediatricians, infectious disease specialists, clinical laboratory diagnostics doctors.

The urgency of the subject is related to lack of uniform approaches by specialists of different profiles to diagnostics and therapy of cytomegalovirus infection in pregnant women and newborns.

Infertility treatment using assisted reproductive technologies in the majority of cases involving the use of various ovarian stimulation protocols to obtain the optimal number of oocytes and embryos.

The use of analogues of gonadotropin-releasing hormone in ART programs prevents the synthesis of endogenous gonadotropins, which is necessary for controlled ovarian stimulation to prevent premature luteinization and obtaining mature oocytes. Although the role of luteinizing hormone (LH) in the process of maturation of follicles and oocytes is not in doubt, the prescription of LH-containing preparations for ovarian stimulation should be performed after individual analysis of clinical and anamnesis data of the patient data and laboratory tests.

A trigger is a firing key (Lat. trigger). A luteinizing hormone is this trigger – a trigger of ovulation at a certain cycle of the ovarial cycle. Understanding of the trigger problem in the artificially cycles of IVF programs requires recollection of certain theoretical issues of follicle growth and maturation as well as the ovulation process in the natural ovarian cycle [1, 2].

The study was conducted in 2016 in four stages on the basis of the department of assisted reproductive technologies of the Moscow Regional Perinatal Center of Balashikha with the purpose to determine the tactics allowing increase of the number of patients who managed to successfully overcome the embryonic threshold after the In Vitro Fertilization  (IVF) and embryo transfer  (ET). Patients were divided in groups with early embryonic losses and the control group. At the following stage of the study determination of the effect of each unfavourable factor on gestation in the first and in the second groups of patients was done. It turned out that such factors as the amount of obtaine oocytes in the course of transvaginal puncture less and equal to 7 (r_k = 0,42, р = 0,005); chronic endometritis supported by histological findings (r_k = 0,74, р = 0,005); disturbance of the receptor status of endometrium  (r_k = 0,71, р = 0,005); coincidence with the spouse by HLA system 3 and higher (r_k = 0,26, р = 0,03); circulation of AB to β-HCG, weakly positive and positive result of the test by the ELISA method statistically significantly affect the early embryonic losses if the patient refused from the proposed correction before IVF (r_k = 0,31, р = 0,005). And on embryonic – innate trombophilias (r_k = 0,78, р = 0,00); acquired thrombophilias (r_k = 032, р = 0,003); chronic endometritis confirmed by histological findings (r_k = 0,64, р = 0,033); circulation failure in the small pelvis by results of the uterine vessel dopplerometry (r_k = 0,66, р = 0,00). Comparison of effectiveness of IVF and ET programs in 2016 was conducted in patients who had and didn’t have the risk factors statistically significantly affecting the outcome. The first two groups of patients were subject to specialized therapy depending on the detected unfavourable factors affecting the outcome of the pregnancy after IVF provided that it was possible to correct this factor with subsequent evaluation of effectiveness of repeated attempts of IVF and ET  in patients after correction of unfavourable factors as compared to the control group. The tactics of minute detection of patients with statistically significant risk factors of early embryonic and embryonic losses, as well as complex preparation of such patients by modern methods allows increasing the number of patients who managed to safely overcome the embryonic threshold after IVF and ET by 20% and finally to positively affect the take baby home indicator.

The combined oral contraceptive containing 20 μg of ethinylestradiol and 3 μg of drospirenone is an effective contraception method with the optimum shortened hormone-free interval and good tolerance predetermined by the positive effect on the body weight, lipid metabolism, general state  and symptoms related to  liquid retention and hyperandrogenism. The data obtained in in vitro and in vivo studies about the role of drospirenone in blocking of adipocyte differentiation and triglyceride accumulation as well as about regulation of the white fat remodeling justify possible effects of this drug on prevention of negative metabolic consequences of the adipocyte dysfunction. Results  of clinical studies are indicative of the body weight reduction and positive effect on the lipid profile without statistically significant effect on insulin sensitivity, which leads to high degree of the women satisfaction with this type of contraception.

The article presents a review of the literature, reflecting the modern aspects of the terminology, classification, pathogenesis, and treatment options of urogenital disorders in women during menopause. This article shows the sensitivity of the lower parts of the urogenital tract to sex steroids, whose importance in the genesis of vaginal and urinary symptoms is not in doubt. These questions about effectiveness of systemic and local hormone replacement therapy and various schemes of treatment regimens was investigated by many scientists in this article.

In the review paper is occurred the possibility of using the food supplements in the treatment of menopausal disturbances as the alternatives of menopausal hormonal therapy. The complex preparations of phytoestrogens, vitamins and amino acids possess broad protective band in the periand postmenopausal periods. A good transference of preparations is noted.

The menopausal hormonal therapy is represented today by ultra low doses in the form of drug Angeliq® Micro, which allows continuing MHT for patients older than 60-65  and choosing an individual MHT type.

Treatment approach Neoplastic epithelial changes (cervical intraepithelial neoplasia, CIN) can be precancerous. Human papillomavirus is considered to be the cause of neoplastic processes.

The article presents data about the frequency of the human papilloma virus associated pathology in the world, Europe and the RF increasing each year. The most frequently occurring pathologic states caused by human papilloma virus are provided. It was stated that the problem of HPV-associated diseases concerns not only women but men. The most frequent types of oncogenic viruses causing the malignant pathology of the reproductive system are Type 16 and 18 viruses. Vaccines providing prevention of the cervical cancer are developed for these two types of viruses. The quadrilent vaccine is effective with respect to lesions of the female genital organs and of the vagina in the form of condylomas. The article demonstrates the first results  of HPVvaccines in various countries of the world that testify about its high effectiveness for anogenital condylomas and precancer cervical changes, that considerably reduced in populations of such countries as Australia, Germany, Sweden etc. Issues on side effects related to application of both vaccines are discussed. Currently according to the conducted survey studies no safety problems were established for women and men when using quardilent as well as bivalent vaccines.

Currently vaccination against HPV is included in national immunization  programs in 60 countries of the world, including 6 countries where vaccination of boys is implemented.

In December 2014, FDA approved the new vaccine Gardasil-9 for girls and women as well as for boys for prevention of precancer lesions of reproductive organs the effectiveness of which is confirmed by results of international multi-center studies.

Uterine myoma is the most common benign monoclonal tumor. The frequency of uterine myoma is 20–35%  in women of reproductive age and reaches 70% after the age of 50. Modern strategy of treatment of uterine myomas are largely individualized and depends on the patient’s age, her desire to preserve reproductive function, as well as the size, location, nodes growth rate, hormone therapy possibility. In recent years more and more articles have been published about the successful use of the progesterone receptor selective  modulator progesterone ulipristal acetate (UPA) for the treatment of uterine myoma. It is important to note that the interest in the problem of uterine myoma therapy by progesterone receptor selective modulators is not only associated with their inhibiting effect on the growth and size of uterine myoma, but with the effect on the endometrium, the  mechanisms of occurrence of amenorrhea and anovulation without reducing endogenous  secretion of estrogen. Drug therapy gives a possibility to postpone or to avoid surgical treatment. In this respect long-term intermittent courses of UPA therapy are currently regarded as the most promising. They allow you expanding the possibilities of conservative treatment of uterine myoma, providing a regression of symptoms of the disease and maintaining the effect after completion of therapy.

Objective – to assess the quality of life (QOL) of women with premenstrual syndrome (PMS) from moderate to severe degree in combination with other symptoms of the menstrual cycle with use of the combined oral contraceptive containing 20 mcg of ethinyl estradiol (EE) and 3 mg of drospirenone (DRSP) under scheme 24/4.

Material and methods. A single-center, prospective, cohort, non-randomized, uncontrolled study was conducted. On the basis of screening of 360 women 27 patients with PMS of moderate and severe forms were selected. The control group consisted of 18 women without PMS. Diagnosis of PMS was based on standardized ICD-10 criteria, the psychological state was assessed by the hospital anxiety and depression scale HADS, QOL index – by the short form of the SF-36 questionnaire. The evaluation was carried out twice – before beginning treatment and in 3 months after the treatment.

Results. Assessment of QOL showed that as compared with the baseline parameters they significantly improved in 3 months of treatment by scales that assess PP (physical pain: 56.0 ± 28.9 vs 76.2 ± 18.9, p = 0.020), RE (role of emotional problems in limitation of life activity: 57.8 ± 21.3 vs 77.9 ± 18.3, p = 0.040), SA (social activity: 42.5 ± 13,5 vs 72,5 ± 12,8, p = 0.050) and MH (mental health: 62,0  ± 7,3 vs 72.0  ± 6.3, p = 0.048).  88.4% of the subjects expressed high satisfaction with the treatment results.

Conclusion. Symptoms of PMS and other disorders of the menstrual cycle successfully stopped for 3 months by a combination of 20EE/DRSP, which is accompanied by a reduction in the incidence of anxiety and depression and improving in QOL.

The issue of the breast feeding has been in existence since the moment of appearance of a man on earth. Breast milk has a unique composition and ratio of proteins, fats and carbohydrates. The nature created a balanced and optimal product containing necessary elements for growth and intellectual development of a child. The breast milk contains a great amount of anti-infection factors protecting the child from the infectious and inflammatory diseases helping to adapt in the aggressive microbe world. It’s primarily ensured by A class immunoglobulin, lysozyme, bifidum-factor. Proteins, fats and carbohydrates making up the composition of the breast milk to a full degree cover the child’s energy demand required for growth of a healthy child. A microelement and vitamin complex completely covers the daily demand for correct exchange processes in the organism of the growing child.

The effectiveness  of mifepristone (Gynestril) use in patients after surgical therapy of uterine myoma (laparoscopic myomectomy, embolization of uterine arteries, hysteroresectoscopy) was studied. It was shown that use of mifepristone at a dosage 50 mg per day in an intermittent regime for 3 months after surgical therapy main myoma of a uterus led to statistically significant reduction of the uterine volume in 96% of women (p < 0.05) and reduction of recurrence of uterine myoma for a year after the drug withdrawal.

The paper presents a review of accumulated data relating to major definitions in diagnostics and therapy of the premenstrual syndrome and own experience represented by case histories. Various therapeutic approaches from the point of view of evidencebased medicine are highlighted.

This article is of practical aspect and is addressed to obstetrician-gynecologists  of the outpatient sphere. Urogynecological pessaries is the first line therapy of pelvic organs prolapse in women and the concomitant urinary incontinence. Their choice is not difficult and each gynecologist must be skilled at it. The article describes in detail the algorithm of the examination required for the selection of the pessary of the correct form and size, which considerably simplifies work of the gynecologist and will help to implement this therapeutic method in his/her day-to-day practice.

Abnormal increase in prolactin hyperprolactinemia is one of the main signs of hypothalamic-pituitary-ovarian dysfunction. Consequently, the effect of dopamine on lactophores is attenuated resulting in their persistent hyperplasia and formation of functionally active microand macro-adenomas followed by an even greater prolactin level increase. According to statistics, prolactinomas are found in 25-30% of women with pathological hyperprolactinemia.