V.F.Snegirev Archives of Obstetrics and Gynecology

This review examines the etiology, pathogenesis, clinical manifestations, and impact of uterine fibroids on reproductive function. Particular attention is given to infertility, pregnancy, and labor in patients with fibroids. Uterine fibroids may be asymptomatic or present with various symptoms, including menstrual irregularities and pelvic pain. The review discusses the effect of fibroids on conception, fetal development, and the risk of pregnancy and labor complications. The influence of fibroids on pregnancy outcomes is determined by their location, size, and number. With the increasing maternal age of women planning pregnancy, the prevalence of uterine fibroids in this population is also rising. As a result, organ-preserving surgical approaches aimed at optimizing reproductive outcomes and reducing pregnancy complications have become a primary treatment strategy. However, the best management strategy that minimizes complications and alleviates symptoms remains undefined. Treatment decisions should be individualized, taking into account multiple factors and requiring thorough patient evaluation. The review underscores the importance of early detection and prevention of pregnancy-related complications in patients with uterine fibroids. Further research is essential to refine preventive measures and optimize treatment strategies for this condition.

Congenital heart defects are the most prevalent developmental anomalies in children and remain a leading cause of infant mortality. According to various sources, the prevalence of congenital heart defects in children varies widely, ranging from 4 to 50 cases per 1000 live births. Given the relative rarity of severe congenital heart defects and the historical lack of interdisciplinary collaboration in this area, research on perinatal cardiac care has often been limited to small case series or single-center studies. The aim of this review is to analyze recent literature on advancements in the perinatal and postnatal management of fetuses and newborns with congenital heart defects, including novel approaches to prenatal diagnosis, antenatal, intrapartum, and neonatal care, as well as to provide recommendations for enhancing accessibility of specialized care and outlining future research directions. A systematic search for publications was conducted using the following keywords and their combinations in both Russian and English: врождённые пороки сердца / congenital heart defects, ВПС/CHD, фетальная кардиология / fetal cardiology, внутриутробная визуализация / intrauterine imaging, фетальная хирургия / fetal surgery. Rapid advancements in fetal cardiac diagnostics, perinatal maternal–fetal monitoring, and in utero surgical interventions have significantly impacted pregnancy outcomes and neonatal prognosis in mother–newborn dyads affected by congenital heart defects. Early fetal echocardiography and routine obstetric screening have enhanced the early detection of pregnancies complicated by congenital heart defects. Novel approaches to prenatal counseling are being explored, and standardized algorithms are being developed to optimize fetal cardiac care, ensuring multidisciplinary perinatal support for families and labor management.

Cervical cancer ranks fourth among all oncological diseases and second among reproductive system malignancies (13.3%), following breast cancer (47.8%). Invasive adenocarcinoma, originating from glandular epithelium, accounts for 21–25% of newly diagnosed cervical cancer cases. Human papillomavirus (HPV) is responsible for up to 92% of cervical cancer cases. This review aims to summarize current approaches to the classification and treatment of cervical adenocarcinoma and identify unresolved challenges. Modern treatment strategies rely on distinguishing HPV-associated and HPV-independent tumors, allowing for more precise adenocarcinoma subtyping and tailored therapeutic strategies. Treatment algorithms for conventional-type adenocarcinoma have been developed, taking into account its specific morphological features, which enable appropriate adjuvant therapy at early disease stages. Significant progress has been made with the introduction of immunotherapy and antibody–drug conjugates into systemic treatment. However, therapeutic advancements for HPV-independent adenocarcinomas remain limited, except for Her2-positive tumors. Retrospective studies highlight differences in cancer outcomes, whereas emerging genetic mutation data may pave the way for more targeted treatment approaches as oncology moves into the era of precision medicine. Currently, treatment approaches for endocervical adenocarcinoma remain similar to those used for squamous cell carcinoma.

BACKGROUND: In reproductive medicine, diminished ovarian reserve remains a pressing challenge, particularly in the search for effective strategies to address it. Surgical methods for ovarian activation are actively being investigated, along with ongoing research into hormonal therapies. In this context, researchers worldwide have focused on the potential application of dehydroepiandrosterone (DHEA) to improve ovarian reserve in women of advanced reproductive age who are planning pregnancy.

AIM: To evaluate the effects of DHEA administration on hormonal profile changes and ovarian reserve parameters in women of advanced reproductive age with diminished ovarian reserve, as well as to assess pregnancy and live birth rates in this population.

METHODS: The study included 118 women of advanced reproductive age diagnosed with diminished ovarian reserve. All participants underwent hormonal evaluation on days 2–3 of the menstrual cycle, including measurements of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, anti-Müllerian hormone (AMH), and inhibin B, as well as folliculometry. The participants were then prescribed DHEA at 75 mg/day, with follow-up hormonal evaluation at 3, 6, and 8 months, along with repeated folliculometry. After treatment completion, data were analyzed, and pregnancy rates were evaluated.

RESULTS: DHEA administration at 75 mg/day for 8 months was associated with a significant reduction in gonadotropin levels (FSH: 9.91 [8.60; 10.90], LH: 7.63 [6.40; 8.60]) and an elevation in estradiol levels (90.22 [78.90; 107.60]; p < 0.001). A significant improvement in ovarian reserve parameters was observed, as evidenced by changes in laboratory markers (AMH: 1.08 [0.76; 1.40], inhibin B: 98.38 [88.60; 111.40]; p < 0.001) and ultrasound folliculometry findings, which demonstrated an increase in antral follicle count to 6–7. A significant reduction in the frequency of menstrual cycle irregularities was observed, with the incidence decreasing to 29.2% (26/118). Pregnancy occurred in 31.3% of women (37/118), with spontaneous conception in 62.1% (23/37) and conception achieved via in vitro fertilization in 37.8% (14/37). A live birth rate of 70.2% (26/37) was recorded, whereas 29.7% (11/37) of pregnancies ended in spontaneous miscarriage.

CONCLUSION: DHEA administration at 75 mg/day for 8 months in women of advanced reproductive age with diminished ovarian reserve is associated with improvements in ovarian reserve parameters and an increased likelihood of achieving a desired pregnancy.

BACKGROUND: Attempts to predict the outcomes of vaginal delivery in women with a uterine scar after cesarean section using highly informative predictors and prognostic models remain highly relevant.

AIM: To demonstrate the significance of antenatal risk assessment for histopathologically confirmed uterine rupture using a scoring system in women with a uterine scar after cesarean section.

MATERIALS AND METHODS: A retrospective multicenter comparative study was conducted on pregnancy and delivery records of 288 patients with a uterine scar after cesarean section. Antenatal risk assessment for histopathologically confirmed uterine rupture was performed using a clinical scoring system (≥5 points=high risk; <5 points=low risk). Group 1 included 135 patients (≥5 points) who underwent elective cesarean delivery; group 2 included 57 patients (<5 points) who underwent elective cesarean section due to obstetric indications; group 3 included 66 patients (<5 points) who delivered vaginally. Group 4 (n=27) was formed to assess the probability of histopathologically confirmed uterine rupture and included cases of scar rupture after cesarean section. The predictive quality of the scoring system was evaluated using ROC analysis, and the significance of each criterion was assessed in relation to uterine rupture. Histopathological examination of the myometrium from the lower uterine segment was performed.

RESULTS: No significant differences in perinatal outcomes were observed among groups 1, 2, and 3. Factors significantly associated with uterine rupture (p <0.0001) included emergency cesarean section, anemia during pregnancy and the postoperative period, pathological blood loss (>1000 mL), and two or more previous cesarean sections. ROC analysis demonstrated a sensitivity of 77.8%, specificity of 95.5%, and accuracy of 83.7%, indicating an excellent predictive quality of the scoring system. The optimal cutoff point was determined to be 6.5.

CONCLUSION: The scoring system accurately predicts histopathologically confirmed uterine rupture, as validated by histopathological examination. A high risk of histopathologically confirmed uterine rupture along the scar following cesarean section is associated with a score of 6 or higher.

BACKGROUND: The annual increase in the number of oncology patients and improvements in their quality of life are among the top priorities of modern medicine. Gonadotoxic treatments lead to premature ovarian insufficiency and infertility. To address this issue, various assisted reproductive technologies (ART) have been developed. First-line approaches for fertility preservation involve oocyte and embryo vitrification. Ovarian stimulation and in vitro maturation (IVM) of oocytes are used to achieve this goal.

AIM: To assess the effectiveness of different ART methods for preserving reproductive material in oncology patients.

MATERIALS AND METHODS: A prospective study was conducted with 48 women of reproductive age diagnosed with oncological diseases. In the first stage, fertility preservation potential was assessed. After stratifying the patients into groups, ovarian stimulation followed by transvaginal oocyte retrieval was performed, or immature oocytes were obtained for in vitro maturation. The collected material was then assessed by an embryologist, who carried out fertilization and vitrification.

RESULTS: The average age of the patients was 33.9±1.7 years, anti-Müllerian hormone levels ranged from 1.26 to 3.02 ng/mL, and the number of antral follicles was approximately 10. In the first group, 256 oocyte-cumulus complexes were retrieved, with 73.0% of them being mature. In the second group, 149 complexes were obtained, with 38.9% suitable for vitrification. Structural abnormalities were more commonly observed in the oocytes matured in vitro. The number of embryos obtained was 161 and 78 in the first and second groups, respectively.

CONCLUSION: Fertility preservation in oncology patients remains a critical challenge in modern healthcare. Ovarian stimulation shows high efficiency in obtaining reproductive material. The in vitro maturation method should be used only as an alternative to ovarian stimulation or in cases of high ovarian reserve.

Ovotesticular disorder of sex development (true hermaphroditism) is a rare form of sex development disorder, accounting for less than 10% of all cases. This condition is characterized by the simultaneous presence of both ovarian and testicular tissue, regardless of karyotype.

This article presents a clinical case of a 61-year-old female patient diagnosed with a disorder of sex development for the first time. During a routine outpatient ultrasound examination, the ovaries appeared enlarged with active blood flow, which was disproportionate to the patient’s age and postmenopausal status. The uterus and cervix were absent. The patient reported primary amenorrhea, no history of pregnancies, and an active sexual life since the age of 20. She had been married since the age of 25 and had never sought medical advice regarding infertility or amenorrhea. Further genetic and cytogenetic analysis revealed a 46,XY karyotype, associated with a high risk of gonadal malignancy. Bilateral adnexectomy was performed. Histological examination confirmed the presence of both ovarian and testicular tissue in the gonads, consistent with a diagnosis of ovotesticular disorder of sex development with bilateral ovotestes. In cases with a 46,XY karyotype, bilateral adnexectomy is indicated due to the significant risk of malignancy.