This journal issue presents studies devoted to actual questions of women's health, including thrombophilia impact on pregnancy, determination of biological age in the reproductive period, and the relationship between placental pathology and thrombophilic disorders. Innovative approaches to diagnostics and treatment are considered, such as plasmapheresis in antiphospholipid syndrome, organ-preserving strategies in placenta accreta spectrum, and prospects for passive fetal monitoring using machine learning. Immune-mediated thrombotic complications, including vaccine-induced thrombotic and heparin-induced thrombocytopenia, are highlighted. Clinical cases of rare pathologies are presented, such as lipodermatosclerosis in pregnant women, complete androgen insensitivity syndrome, and laparoscopic cerclage for cervical insufficiency. The final material is dedicated to Robert Edwards historical role in the development of in vitro fertilization.

Aim: to study a pattern of genetic and acquired thrombophilia in pregnant women with severe early-onset (eoPЕ) and severe lateonset (loPЕ) preeclampsia (PE).

Materials and Methods. A retrospective cohort study was conducted from January 2022 to May 2024. A total of 109 pregnant women were examined: group 1 – 45 women with eoPЕ (< 34 weeks of pregnancy), group 2 – 24 women with loPЕ (≥ 34 weeks of pregnancy), group 3 (control) – 40 women with physiologically uncomplicated pregnancy. All pregnant women were examined for lupus anticoagulant (LA) and antiphospholipid antibodies (aPL). The screening test for aPL included the quantitation of IgG/IgM antibodies against cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidic acid, and β2-glycoprotein 1 in serum or plasma using an enzyme immunoassay. Genetic thrombophilia, homocysteine, and ADAMTS-13 metalloproteinase (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) levels were also determined.

Results. Pregnant women with severe PE more often had genetic forms of thrombophilia (mutations in factor (F) V Leiden gene, prothrombin G20210A, and Thr165Met) and a deficiency of natural anticoagulants (antithrombin and protein S) compared to pregnant women in control group. Women in eoPE vs. loPE group were more often found to carry genetic polymorphisms in the plasminogen activator inhibitor-1 (PAI-1) and fibrinogen genes. Also, in the group of pregnant women with eoPE, the circulation of aPL, ADAMTS-13 inhibitor, and elevated homocysteine levels were more common. Pregnant women with loPE were older and more often suffered from hypertension, diabetes mellitus, and excess body weight. No significant differences between eoPЕ and loPЕ groups were found while comparing prevalence of autoimmune diseases, thrombosis in familial history, mutations in FV Leiden gene (heterozygous form), FII prothrombin gene G20210A (homozygous form), FII prothrombin gene Thr165Met (heterozygous form), antithrombin III deficiency, protein S deficiency.

Conclusion. Precise causes underlying PE remain unknown, andwe are still far from understanding all the molecular, immunological, genetic, and environmental mechanisms that lead to the various clinical manifestations of placental syndromes including PE. However, the study results suggest that the presence of thrombophilic disorders, especially in the fibrinolytic system, and aPL circulation contribute to eoPE pathophysiology or progression.

Introduction. Biological age (BA) reflects the characteristics of the morphological and physiological state of the human body at a specific period of its life.This concept is of particular importance in reproductive medicine, because actual age does not always correlate with the state of organs and systems.

Aim: to develop a method for calculating BA for women aged 20–45 years, considering their physiological state and reproductive function.

Materials and Methods. A single-stage non-randomized cohort study was conducted. To create the BA calculation model, a study was conducted with 100 healthy women aged 20–45 years. Seventy-eight parameters were analyzed, including anamnesis data, anthropometric parameters, data of general blood test, biochemical blood test, instrumental studies, assessment of overall antioxidant status (ОAS), from which the most informative variables were selected. The model was developed using multiple linear regression.

Results. The most informative indicators for calculating BA were: ОAS, static balance time (SBT), body mass index (BMI), and number of former pregnancies. The developed BA calculation formula demonstrated high accuracy, correlating with chronological age (correlation coefficient of 0.947).

Conclusion. The proposed BA calculation method is specifically designed for women of reproductive age and shows high accuracy and correlation with chronological age. The inclusion of antioxidant protection parameters, functional state indicators, and reproductive history makes the method versatile and applicable not only in reproductive medicine but also in general medical practice, obstetrics, gynecology, and other fields.

Aim: to test the hypothesis about a connection between genetic and acquired thrombophilia, as well as the characteristics of delivery in women with placental abnormalities.

Materials and Methods. A prospective controlled cohort non-randomized interventional study assessing the characteristics of delivery and the presence of thrombophilia was conducted in 135 women with placental abnormalities. Pregnant women were divided into 3 groups: group 1 included 42 women with a history of placental abnormalities; group 2 – 61 pregnant women with placenta previa first discovered during ongoing pregnancy; group 3 – 32 women with recurrent placenta previa. The control group included 120 pregnant women who had a normal placenta position and no complicated obstetric history. All women had a clinically assessed course of pregnancy, underwent ultrasound, testing for congenital and/or acquired thrombophilia by detecting antiphospholipid antibodies (APA), identification of genetic forms of thrombophilia: mutations in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, mutations in the prothrombin gene G20210A, factor V Leiden mutations, assessment of present fibrinogen and plasminogen activator inhibitor 1 gene polymorphism.

Results. Thrombophilia was found in a significant percentage of patients with placenta previa (74.81 %), and the majority – with the multigene form belonged to group 3. The combination of genetic thrombophilia and APA circulation was detected in 22.22 % of patients. Signs of fetal growth restriction (FGR) were identified in all study groups: 4 (9.52 %) in group 1, 6 (9.84 %) in group 3, 6 (18.75 %) in group 3 and in 6 (6.67 %) in control group. All patients in the study groups underwent delivery by cesarean section (CS) – in 31 patients it was premature at 35–37 weeks due to increased fetoplacental insufficiency and the development of fetal distress syndrome: in 10 (23.8 %) pregnant women of group 1, in 12 (19.7 %) of group 2, and in 9 (28.1 %) women from group 3. In 104 women, CS was performed at 37–38 weeks of gestation. In the group of women with recurrent placenta previa (group 3) the frequency of complications during delivery significantly differed from similar those in groups 1 and 2 (p < 0.05) and control group (p < 0.001): 13 (40.6 %) cases of uterine hypotension were identified, 6 (18.8 %) uterine atony cases and 5 (15.6 %) cases of placenta accreta, which required hysterectomy in 7 (21.9 %) patients. In 4 (12.5 %) cases, clinically significant signs of deep vein thrombosis (DVT) were detected.

Conclusion. The study results indicate a connection between placenta previa, genetic thrombophilia and emergence of complications during delivery. The need to adjust approaches to the management of pregnancy delivery by taking such risk factors into consideration was discovered.

Aim: to study plasmapheresis (PP) effect on antiphospholipid syndrome (APS) treatment during preconception preparation and pregnancy.

Materials and Methods. A single-center, prospective, randomized, uncontrolled study was conducted. A total of 137 women aged 22 to 32 years diagnosed with APS-related habitual miscarriage were examined. The patients were stratified as follows: main group consisted of 73 patients underwent a PF course (7 procedures at preconception preparation stage); comparison group – 64 patients not underwent efferent therapy. Antiphospholipid antibodies (APA) circulation was determined by solid-phase immunofluorescence. PР was performed using an intermittent technique. The laboratory study included assessing titers of lupus anticoagulant (LA), anti-cardiolipin antibodies (aCL), anti-β2-glycoprotein 1 antibodies (anti-β2-GP1) and anti-annexin V antibodies (anti-ANX). Antibody titers were measured before and after pregravid preparation.

Results. After PР, anti-β2-GР1 titers decreased by 66.6 % (p = 0.00001) in main group. In patients who underwent standard therapy without PР, no significant changes in circulation level of anti-β2-GР1 were noted. LA frequency in main and comparison group decreased by 57.3 % (p = 0.042) and 10.9 % (p = 0.69), respectively.

Conclusion. The frequency of detecting elevated AРA levels in women after a course of efferent therapy decreased significantly, whereas standard therapy showed no such effects. PР as part of complex therapy is more appropriate for achieving maximum effect.

Aim: to study the spectral characteristics of blood plasma in pregnant women with benign ovarian formations (OF).

Materials and Methods. A retrospective study conducted between 2021 and 2023 included 100 pregnant women aged 18 to 45 years. Two groups were identified: group 1 (main group) included 50 pregnant women with OF, group 2 (control group) included 50 pregnant women with normal pregnancy. Using the method of surface-enhanced Raman spectroscopy (SERS), we determined and assessed the spectral features typical to OF, which are necessary for differential diagnosis of this pregnancy-related pathology.

Results. Prominent inter-group differences in spectral intensities were revealed: OF was associated with significantly increased intensity of spectral peaks at 491 nm, 596 nm, 632 nm, 808 nm, 886 nm, 1132 nm and decreased intensity at the peaks of 725 nm and 1440 nm observed compared to control group. After OF removal, spectral pattern restored to near complete compliance with the spectral pattern observed in control group of pregnant women.

Conclusion. The isolated and analyzed spectral features demonstrated an opportunity of using SERS in diagnosing OF in pregnant women.

Introduction. Prenatal diagnostics of fetal vital activity includes regular assessment of parameters such as heart rate (HR), motor activity and physiological state. Current methods of fetal monitoring based on using active ultrasound waves have a number of limitations: insufficiently high diagnostic sensitivity and specificity, lack of prognostic significance and impossible long-term use. These limitations necessitate a development of innovative technologies for assessing fetal functional state.

Aim: to summarize advanced global developments as an alternative to ultrasound systems for long-term fetal monitoring, allowing continuous real-time recording of fetal vital signs by using passive sensors and trend analysis with potentially high diagnostic and prognostic accuracy.

Materials and Methods. The review methodology included an analysis of publications released over the past 10 years, included based on relevance criteria. Publications were selected in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The following keywords in Russian and English were used for selection: "modern methods of prenatal diagnostics", "fetal monitoring", "assessment of fetus functional state", "passive sensors", "artificial intelligence", "machine learning". The search yielded 69 articles in the PubMed/MEDLINE database, 17,500 – in Google Scholar, 21 – in eLibrary, and 3,563 – in ResearchGate. Such articles were analyzed for relevance, relevance to the review topic, and availability of experimental data. Non-peer-reviewed publications and duplicates were also excluded from the reviewed materials. The most relevant 8 articles were included in the review, which describe promising methods of prenatal diagnostics based on the use of passive sensor experimental devices.

Results. The conducted literature analysis allowed to generalize the experimental achievements of current methods of prenatal diagnostics and demonstrated great promise for automated systems to assess fetal vital signs, including monitoring fetal HR, motor activity and general functional state. However, it was found that none of the described systems achieves 100 % accuracy of the results corresponding to fetal cardiotocography and ultrasound examination data. Most experimental systems remain wired, which limits their use for fetal monitoring. Promising passive monitoring systems are based on using accelerometers, microphones and other sensors to assess fetal functional state. A key component of such technologies is the use of artificial intelligence for signal processing and interpreting, which increases the accuracy and monitoring information content. The main problem is generation of effective data processing algorithms for their accurate and unambiguous interpretation. All the technologies under consideration are still experimental, and further work is required to improve the algorithms and integrate various types of sensors to ensure comprehensive analysis.

Conclusion. It is noteworthy that technologies employing passive sensors for continuous and long-term monitoring of fetal vital signs, in conjunction with machine learning algorithms for data analysis and interpretation are of particular interest. The use of wearable devices, based on passive sensors such as accelerometers and digital microphones, has the potential to enhance prenatal diagnostics, ensuring both enhanced safety and the early detection of pregnancy complications and fetal conditions.

Introduction. Placenta accreta spectrum (PAS) is the preferred term approved by most international organizations that refers to the range of pathologic adherence of the placenta. PAS is a serious problem with incidence rate of 1/272 in-labor women. Today, peripartal hysterectomy is considered as the generally accepted global practice for PAS management, however, this approach is related to high level of maternal mortality and the impossibility of pregnancy in the future.

Aim: to analyze publications on the available methods for PAS diagnostics and management by highlighting organ-preserving treatment including assessment of relevant risks and benefits compared with other methods as well as prospects for patients.

Materials and Methods. Research papers were searched for in the databases eLibrary, PubMed and Google Scholar released until August 2024. The following search queries were used: "placenta accreta spectrum", "PAS", "PAS and organ-preserving treatment", "PAS and peripartum hysterectomy", "PAS and organ-preserving management". The selection of articles was carried out in accordance with the recommendations of PRISMA initiative that allowed to analyze 75 publications included in the review.

Results. Organ-preserving PAS treatment is a reasonable alternative to peripartal hysterectomy, because it provides better results with lower risk to maternal health. It is worth noting that each of these methods has own unique features. For instance, organpreserving treatment may last longer to achieve a desired result, but at the same time it can reduce a risk of complications and improve a woman's quality of life in the long term. Along with this, peripartal hysterectomy may be more effective in the short term, but it is associated with a higher risk of complications.

Conclusion. A doctor should provide a woman with all the necessary information about the risks and benefits of each method, as well as help a woman make an informed decision based on her individual needs and preferences. Organ-preserving PAS treatment contributing to preserve fertility offers a better quality of life with lower risk to maternal health. Ultimately, a choice between peripartal hysterectomy and organ-preserving treatment depends on a specific situation as well as woman's state of health.

Aim: to carry out a comparative analysis of the pathogenesis, clinical manifestations, diagnostic criteria as well as therapeutic strategies of vaccine-induced thrombotic thrombocytopenia (VITТ) and heparin-induced thrombocytopenia (HIT), two rare but potentially life-threatening conditions associated with antibody-dependent platelet activation.

Materials and Methods. Current data on the pathogenesis, epidemiology, clinical presentation, diagnosis, and treatment of VITТ and HIT have been reviewed including an analysis of existing diagnostic scoring systems, laboratory tests, and therapeutic approaches. The study is based on the data obtained from systematic reviews, clinical studies, and up-to-date clinical guidelines.

Results. VITТ and HIT share a common pathophysiological mechanism involving the production of antibodies against platelet factor 4 (PF4) and subsequently developing thrombotic complications. However, a key difference lies in the triggers of the immune response: HIT is induced by heparin exposure, whereas VITТ develops following the administration of adenoviral vector vaccines against SARS-CoV-2. HIT is primarily characterized by venous thrombosis, while VITТ predominantly manifests with atypical thromboses, including cerebral venous sinus thrombosis. Both conditions require immediate medical intervention; however, HIT management involves discontinuation of heparin and the initiation of using alternative anticoagulants, whereas VITТ treatment requires administration of intravenous immunoglobulins and anticoagulants, including heparin-based agents.

Conclusion. Despite their rarity, VITТ and HIT pose significant health risks to patients. Modern diagnostic methods, including the 4Тs scoring system and serological testing, facilitate the timely identification of HIT, whereas VITТ diagnostics remains a complex challenge and requires further standardization. Optimizing therapeutic strategies, including the use of novel anticoagulants and immunosuppressive approaches, is a priority task to reduce mortality and improve patient outcomes.

Pregnancy and childbirth in women with varicose vein disease (VVD) are typically associated with a high risk of developing thrombotic, obstetric and fetal complications. Lipodermatosclerosis (LDS) is one of the less common complications related to chronic venous insufficiency (CVI). This article presents a clinical case where LDS developed during late-stage pregnancy (35–36 weeks) as a complication of pre-existing VVD, which is noteworthy due to the rarity of such condition that demonstrates relevant diagnostic challenges particularly during pregnancy. Enhancing the effectiveness of a multidisciplinary approach is essential for diagnosing rare VVD complications in pregnant women.

Miscarriage remains one of the most pressing challenges in modern obstetric practice, markedly impacting birth rates and women’s health. One of the manageable miscarriage causes is presented by cervical insufficiency (CI) occurring in 0.2–2.0 % of all pregnant women and in 15.5–42.7 % of those with habitual miscarriage. Both conservative and surgical treatments, such as the use of obstetric pessaries or cerclage, are applied to prevent CI-related preterm birth. Transvaginal cerclage remains the most common procedure for CI correction. However, in certain situations, transvaginal cerclage may be inapplicable or ineffective due to prior cervical scarring, conization, or other anatomical alterations. In such cases, transabdominal cerclage (TAC) can be considered as an alternative. TAC, either performed via laparotomy or laparoscopy, has demonstrated successful pregnancy outcomes in 81–89 % of cases. This article provides a brief literature review on CI surgical treatment and presents a clinical case of successful pregnancy after laparoscopic TAC. The patient, with a history of severe cervical pathology and multiple pregnancy losses, underwent a laparoscopic TAC at 13 weeks and 3 days of gestational age using the Cervix-set tape. The pregnancy was carried to term, and a healthy baby was delivered via planned cesarean section at gestational age of 38 weeks. Thus, laparoscopic TAC is an effective alternative for patients with complex cervical anatomy requiring more advanced surgical intervention. This procedure achieves high success rates for prolonging pregnancy and ensuring favorable outcomes while minimizing risks for both mother and child.

Complete androgen insensitivity syndrome (CAIS) is a rare X-linked sexual development condition typified by 46,XY karyotype, presence of external female genitalia along with intra-abdominal testes in labia majora or inguinal ring region. This syndrome results from alterations in the androgen receptor (AR) gene leading to primary amenorrhea and uterine agenesis (Müllerian agenesis) in adolescent teens or two-sided labial/inguinal hernia with testes in children around prepubertal age. Our paper reports a case of CAIS in a 16-year-old woman with no menarche and 46,XY karyotyping. Gonadectomy results showed hyperplasia of Leydig cells. The current research encompasses the case report and the available knowledge to date on the understanding, diagnosis, treatment, and management of CAIS.

Here, we discuss the historical aspects of the life and scientific work of the British scientist Robert Geoffrey Edwards, who made a significant contribution to the development of reproductive medicine and genetics. Having begun with studying mouse physiology, together with colleagues he succeeded in proposing in vitro fertilization technique, which in 1978 led to the birth of Louise Brown, the world's first "test-tube baby". In 2010, Dr. Edwards was awarded the Nobel Prize in Physiology or Medicine for the development of human in vitro fertilization.