V.F.Snegirev Archives of Obstetrics and Gynecology

The urinary and reproductive organs are closely related in their development. Most of them originate from the mesoderm and, in early embryogenesis, represent a single developmental process. Clear cell ovarian carcinoma and clear cell renal cell carcinoma share similar histological features and an aggressive clinical course. Ovarian cancer is the eighth most common cancer in women worldwide. Clear cell ovarian carcinoma is a rare histological subtype, accounting for approximately 5% of all ovarian tumors. Clear cell renal cell carcinoma is the most common histological subtype of kidney tumors, comprising 80%–85% of all renal neoplasms, and is more frequent in men. Based on current international and national studies, this article evaluates the diagnostic value of immunohistochemical markers including HNF1B, napsin A, IMP3, CD10, SR-B1, PAX-8, CAIX, AMACR, and Ki-67 to identify similarities and differences between these tumors and to explore the potential use of these markers in differential diagnosis, particularly in challenging clinical situations, such as the evaluation of women to rule out metastatic disease.

Currently, the number of women who become pregnant with comorbidities is growing, including eye diseases (myopia, glaucoma, diabetic retinopathy, and others). This is influenced by several factors, among which age plays a significant role. Unfortunately, this topic receives less attention than other extragenital conditions and complications of pregnancy and the postpartum period. However, underestimating eye diseases can affect the course of pregnancy, including increasing obstetric risks and influencing the postpartum period. Importantly, some eye diseases may worsen during pregnancy, thereby considerably compromising the postpartum period and, consequently, the quality of newborn care. A review of studies on this topic shows that hormonal and physiological changes during pregnancy can exacerbate existing eye diseases or contribute to their development, as well as affect fetal health and the prognosis of pregnancy and the postpartum period. Consequently, changes in a woman’s condition after delivery, deterioration in quality of life, and inability to provide adequate attention to the child can adversely affect the psycho-emotional well-being of the mother.

Modern medicine increasingly recognizes the pivotal role of the microbiome in health; however, its influence on reproductive function and related disorders remains insufficiently understood in a comprehensive context. This review analyzes the general concepts of the microbiome and holobiont and their clinical relevance for obstetrician-gynecologists, reproductive medicine specialists, and andrologists, with particular emphasis on dysbiosis and small intestinal bacterial overgrowth (SIBO). The growing prevalence of infertility, pregnancy loss, and other reproductive disorders potentially linked to microbial imbalance underscores the relevance of this topic.

The review provides contemporary definitions of the microbiome as a microbial community and its functional sphere, and the holobiont as an integrated system comprising the host and all associated microorganisms that function as a single unit. The main functions of the human microbiome are discussed in detail, including digestion, immune system education, pathogen protection, and nutrient production. Special attention is given to the impact of dysbiosis and SIBO on systemic processes such as metabolic endotoxemia and increased intestinal permeability, which lead to chronic inflammation and autoimmune reactions.

The novelty of this work is the systematic review of the relationship between gut dysbiosis and reproductive health, including its effects on infertility, implantation failure, polycystic ovary syndrome, endometriosis, spermatogenesis, and the risk of reproductive cancers. Readers will gain a deeper understanding of the mechanisms by which microbiome disturbances, particularly SIBO, can negatively affect male and female fertility, and learn about potential clinical consequences such as autoimmune conditions, metabolic disorders, and urogenital microbiota changes—which is critical for reproductive medicine specialists.

BACKGROUND: Endometrial polyps are a benign intrauterine condition whose etiology remains unclear. Altered uterine microbiota is one possible contributing factor. Furthermore, recurrence rates after polypectomy remain high, making postoperative management to reduce recurrence a relevant issue.

AIM: To identify predictors of endometrial pathology recurrence in patients after polypectomy.

METHODS: The study included 147 reproductive-age patients with endometrial polyps who underwent polypectomy. Postoperative hormonal therapy was given to 123 (83.7%) patients, while 24 (16.3%) declined it. We analyzed the association between recurrence and the recommended treatment, and between recurrence and vaginal microflora characteristics.

RESULTS: No patient who received a levonorgestrel-releasing intrauterine system (LNG-IUS) required repeat surgery. Combined oral contraceptive (COC) use reduced the likelihood of hysteroscopy with diagnostic curettage 2.6-fold compared with patients who declined treatment, and cyclic progestogen use reduced it 1.9-fold compared with the observation-only group. Bacterial vaginosis was associated with a 3.4-fold higher reoperation rate than other vaginal microflora states.

CONCLUSION: After polypectomy, to prevent abnormal uterine bleeding, LNG-IUS placement or COC use should be considered for women who need contraception. In addition, timely detection of vaginal dysbiosis during follow-up is important, as it affects the incidence of endometrial proliferative disease.

BACKGROUND: Cervical cancer is one of the leading causes of cancer-related mortality among women aged 30–34. Late diagnosis remains a critical issue, with >40% of cervical cancer cases being first detected at stage III–IV. Although extended colposcopy is an important step in the diagnosis of precancerous conditions and cervical cancer, obtaining a colposcopic report may be challenging due to a lack of equipment or qualified specialists in some settings. Therefore, AI-based analysis of colposcopic images is a promising component of comprehensive cervical disease diagnosis.

AIM: To analyze the efficacy of comprehensive diagnosis and detection of precancerous cervical lesions and cervical cancer.

METHODS: In 2024–2025, at the Department of Obstetrics and Gynecology No. 1 of the N.V. Sklifosovsky Institute of Clinical Medicine, Sechenov University, we analyzed data from 42 patients aged 18–45 years who had grade 2 abnormal colposcopic findings on routine extended colposcopy. All patients underwent a comprehensive workup, including history taking, gynecological examination, clinical description, HPV testing, Papanicolaou (Pap) cytology of ecto- and endocervical scrapings, and extended colposcopy. Anonymized colposcopic images were uploaded to AI software, which processed the images without a predefined diagnosis and generated an automated conclusion for each case without human intervention. The system’s conclusion was then compared with the consensus conclusion of a medical board comprising three obstetrician-gynecologists.

RESULTS: Agreement between the AI system and the medical board was 92.8% (39 cases). Discrepancies were observed in only 3 cases (7.2%), in which the medical board classified the colposcopic images as grade 2 abnormal, whereas the AI-based software identified grade 1 abnormal findings.

CONCLUSION: AI-based interpretation of extended colposcopy data can identify patients at risk of cervical disease for further examination and early detection of precancerous changes and cervical cancer. In our study, the sensitivity of the diagnostic method was 92.9%; however, it should be emphasized that for clinical diagnosis, AI findings in at-risk patients must be confirmed by histological examination.

BACKGROUND: Despite the increasing rate of labor induction, particularly for fetal and maternal indications, the contribution of specific obstetric complications to failed induction remains understudied. Existing studies primarily compare induction with expectant management or spontaneous labor in the presence of a given pathology. This study aims to address this gap by analyzing various indications in a single cohort.

AIM: To analyze the indications for labor induction and evaluate its efficacy.

METHODS: We analyzed medical records of 1,571 women with singleton pregnancies who underwent induction at ≥37 weeks. Patients were stratified by indication: gestational age ≥41 weeks, gestational diabetes mellitus, gestational hypertension, large-for-gestational-age fetus, moderate preeclampsia, chronic hypertension, polyhydramnios, oligohydramnios, intrahepatic cholestasis of pregnancy, complicated obstetric history, and fetal growth restriction. Successful induction was defined as vaginal delivery.

RESULTS: The overall cesarean delivery rate after induction was 21% (n = 327): 26% (n = 294) in nulliparous and 8% (n = 33) in multiparous women. The highest risk of failed induction was observed for chronic hypertension in nulliparous women (p = 0.005; OR 1.95; 95% CI 1.21–3.15); and for moderate preeclampsia and complicated obstetric history in multiparous women (p = 0.010; OR 3.39; 95% CI 1.28–9.00 and p < 0.001; OR 6.44; 95% CI 2.27–18.29, respectively). Successful induction was associated with intrahepatic cholestasis of pregnancy in nulliparous women (p = 0.043; OR 0.35; 95% CI 0.12–1.01). A large fetus as the sole indication significantly increased cesarean risk (p = 0.004; OR 1.84; 95% CI 1.21–2.81); however, as a coexisting condition with other pathologies, its predictive value was lost (p = 0.237; OR 0.56; 95% CI 0.19–1.61). In multiparous women, induction outcome was most accurately predicted by considering multiple factors (BF₁₀ = 3.58, R² = 0.073).

CONCLUSION: In nulliparous women, the risk of failed induction was increased with chronic hypertension and decreased with intrahepatic cholestasis. In multiparous women, the outcome was determined by a combination of factors. A large fetus as the sole indication increased the risk of cesarean delivery, but as a coexisting condition with other indications, it did not affect the outcome.