Introduction. Coronavirus infection is associated with severe endotheliopathy, thromboinflammation and immunothrombosis leading to excessive release of von Willebrand factor (vWF) multimers from Weibel–Palade bodies, which can affect activity of ADAMTS-13 metalloproteinase (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) and the ADAMTS-13/vWF axis previously shown by us to be altered in non-pregnant women with severe COVID-19.  

Aim: to study a clinical role of hemostasis activation particularly ADAMTS-13/vWF axis in pregnant women after COVID-19.  

Materials and Methods. A prospective case–control study was conducted with pregnant women (n = 135) divided into 3 groups: group 1 included 45 women with prior COVID-19 during pregnancy, group 2 – 45 women in the acute phase of the infection during pregnancy, group 3 – 45 healthy pregnant women. The level of vWF and ADAMTS-13 was assessed in all patients.  

Results. The concentration of vWF antigen (vWF:Ag) in the acute period of the disease in pregnant women with COVID-19 was significantly higher compared to the control group (p < 0.001). ADAMTS-13 level in pregnant women after COVID-19 did not differ from that of in control group, while vWF level was significantly higher in 66.7 % (30/45). The ADAMTS-13/vWF ratio was increased and significantly differed both in pregnant patients during the acute period of the disease (p < 0.001) and pregnant women after infection (p = 0.0002) compared with the control group.  

Conclusion. Our results show that endotheliopathy was prominently manifested in pregnant women with COVID-19 and persisted for several months after disease. The ADAMTS-13/vWF ratio determines the pathway functioning, the risk of microcirculation disorders and clinical complications. 

Aim: to identify potential causes accounting for development or predisposition to congenital neuropsychiatric disorders (NPD) in childhood and assessing an opportunity for conducting preventive interventions to lower a risk of childbirth coupled to congenital malformations.

Materials and Methods. The pediatric medical records with NPD and psychomotor retardation were analyzed: data on the pattern of pregnancy and maternal delivery-related complications as well as delivery-associated complications and fetal developmental abnormalities, the maternal morbidity pattern before and during pregnancy; data on paternal health state as well as available social information about parents were also assessed.

Results. It was revealed that potential causes for delivery of children with NPD and subsequent development of psychomotor retardation were due to complications during pregnancy such as infections of pregnant women, gestosis, anemia; among maternal complications in childbirth of special attention were long anhydrous period as well as surgical interventions.

Conclusion. The course of pregnancy and childbirth as well as emerging neonatal pathology may be also influenced by the climatic and meteorological conditions of the Arctic zone causing Arctic hypoxia. Significant correlations between solar wind parameters and morbidity of pregnant women may indicate a need for more extensive studies regarding effects of geocosmic factors on course of pregnancy, childbirth and fetal gestation.

Aim: to assess an effectiveness of medical rehabilitation after radical surgical treatment of endometrial cancer (EC).  

Materials and Methods. Post-surgery EC patients were stratified into two groups: the main group included 29 women who underwent the proposed program of complex "active" medical rehabilitation, the comparison group – 32 patients treated in accordance with the approved clinical guidelines. Body mass index (BMI), waist and hip measurements, atherogenic index, serum glucose, leptin, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were analyzed at week 1, as well as 3, 6 and 12 months later.  

Results. Significant inter-group differences were observed 6 and 12 months later during the follow-up. Starting from 6 months after EC surgical treatment, in the main group BMI decreased reaching 31.14, whereas in the comparison group, it increased up to 35.07 (p < 0.05). Differences in waist and hip measurements became significant by month 6 and 12, respectively, after the onset. The glucose level in the main and comparison group 6 months later was 6.16 ± 0.24 mmol/l and 6.16 ± 0.33 mmol/l, respectively; in the main group it decreased to the norm at month 12 comprising 5.09 ± 0.30 mmol/l, whereas in the comparison group it was higher than normal range reaching up to 5.87 ± 0.27 mmol/l (p < 0. 05). The decrease in the atherogenic index in the main vs. comparison group, which plateaued, became significant at month 6 and 12, respectively. A decrease in serum leptin, TNF-α and IL-6 level was found in the main group, but not in the comparison group.  

Conclusion. For the first time, a phenomenon of dynamically decreased level of serum pro-inflammatory markers was established during the complex "active" medical rehabilitation of women after radical surgical EC treatment. In addition to the previously verified improvement in the quality of life based on subjective questionnaires and scales, the effectiveness of the proposed medical rehabilitation program for such patients was confirmed by objective methods. This rehabilitation program can be recommended to all EC females in the recovery period after surgical treatment. 

Aim: to demonstrate efficacy and safety of iron (III) hydroxide oligoisomaltosate in patients with iron deficiency.  

Materials and Methods. An observational cohort study was conducted: 31 patients were examined – 10 puerpera patients, 13 pregnant women, 8 gynecological patients suffering from iron deficiency anemia, stage 1–3. After further examination (biochemical blood test – ferritin, iron, latent iron binding capacity, total calcium, inorganic phosphorus, transferrin, C-reactive protein), therapy with "Monofer" (iron (III) hydroxide oligoisomaltosate) was performed. Four weeks after the final drug administration, the efficacy and patient satisfaction were monitored.  

Results. During the examination, significant changes in the following parameters were found: erythrocyte count increased after therapy by 1.3-fold, hemoglobin – by 26.5 g/L, hematocrit – by 0.58 % (p = 0.00). Biochemical blood test data also showed positive dynamics: ferritin was higher by 216.21 ng/ml, latent iron binding capacity – lower by 30.73 µmol/l, transferrin – lower by 1.17 g/L, iron level – higher by 6.87 µmol/l, modestly increased total calcium – by 0.14 mmol/l, and inorganic phosphorus – by 0.1 mmol/l. Patients surveyed according to the Likert scale showed a high degree of satisfaction with treatment. No adverse effects (AE) and Serious Adverse Effects (SAE) occurred during the study.  

Conclusion. A significant increase in the parameters of the qualitative and quantitative composition of blood cell count and biochemical parameters has been achieved. Posttransfusion hypophosphatemia and hypocalcemia were not observed in the studied patients. High satisfaction with the treatment and drug safety in patients were noted. 

Introduction. One of the leading causes in the mortality pattern of cancer patients is accounted for by thrombotic complications. Recent studies have shown that neutrophil extracellular traps (NETs) are involved in the activation of coagulation, contribute to the initiation and progression of thrombosis. In addition, NET-related effect on tumor progression and metastasis has been actively studied.

Aim: to evaluate NET-related procoagulant activity in gynecological cancer patients.

Materials and Methods. From April 2020 to October 2022, a prospective controlled interventional non-randomized study was conducted with 120 women. The main group included 87 patients aged 32 to 72 years with malignant neoplasms of the female genital organs and mammary glands who were hospitalized for elective surgical treatment or chemotherapy: uterine body cancer (subgroup 1; n = 18), ovarian cancer (subgroup 2; n = 26), cervical cancer – adenocarcinoma of the cervical canal (subgroup 3; n = 13), breast cancer (subgroup 4; n = 30). The control group consisted of 33 healthy women aged 32 to 68 years. In all women, plasma concentrations of citrullinated histone H3 (citH3), myeloperoxidase antigen (MPO:Ag), D-dimer, and thrombin–antithrombin (TAT) complexes were evaluated.

Results. The magnitude of NETosis in cancer patients, assessed by level of citH3 (2.5 ± 0.7; 1.9 ± 0.8; 2.5 ± 0.7; 0.7 ± 0.5 ng/ml in four subgroups, respectively) and MPO:Ag (29.5 ± 13.1; 12.8 ± 3.7; 22.8 ± 8.7; 6.6 ± 2.5 ng/ml in four subgroups, respectively) was significantly higher compared to women in the control group (0.3 ± 0.1 ng/ml; p = 0.0001 and 2.5 ± 0.2 ng/ml; p = 0.0001). In parallel with increased NETosis markers in accordance with the disease stage, there was an increase in the concentration of hemostasis activation markers – D-dimer (1.7 ± 0.6; 2.0 ± 0.7; 1.4 ± 0.5; 1.5 ± 0.7 µg/ml in four subgroups, respectively) and TAT complexes (729.8 ± 43.9; 794.1 ± 164.8; 636.2 ± 149.5; 699.6 ± 165.7 pg/ml in four subgroups, respectively) exceeding their level in the control group (respectively, 0.4 ± 0.1 μg/ml; p = 0.0001 and 362.3 ± 0.1 pg/ml; p = 0.0001). The maximum values of parameters occurred at later stages according to the Classification of Malignant Tumours (tumor, nodus, metastasis, TNM). A significant correlation between TAT level and the concentrations of citH3 (r = 0.586; р = 0.04) and MPO:Ag was revealed (r = 0.631; р = 0.04).

Conclusion. Tumor tissue creates milieu that stimulates NETs release, which, in turn, not only contribute to the creating a procoagulant state, but also might act as one of the factors that ensure tumor progression and metastasis. The development of targeted therapies acting on NETs has a potential to affect hemostasis in cancer patients and reduce rate of tumor growth and metastasis.

Introduction. Primary hypothyroidism is observed in women of reproductive age in 2–3 % of cases. The most common thyroid pathology during pregnancy is subclinical hypothyroidism (SHT), which is caused by newly diagnosed autoimmune thyroiditis (AIT) or severe iodine deficiency. In some regions of the Russian Federation, the population has a mild iodine deficiency, the average concentration of iodine in the urine being found at 78 µg/L (the normal range is 100–200 µg/L). In women with primary hypothyroidism, complications of pregnancy and childbirth include: premature birth, weakness of labor, eclampsia, premature rupture of premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), intrauterine growth retardation syndrome, fetal macrosomia, congenital hypothyroidism in the fetus, etc.

Aim: to study the features of pregnancy and childbirth course in women with primary hypothyroidism.

Materials and Methods. In a retrospective study, there were analyzed 62 birth histories, of which 37 were for patients with thyroid diseases. Two groups were formed: the main group – 25 patients with primary hypothyroidism, the comparison group – 25 patients without thyroid pathology. During the study, the next parameters were analyzed: age, number of pregnancies, number of births, term of delivery, body mass index, level of thyroid stimulating hormone (TSH), titer of thyroid peroxidase antibodies, newborn body weight, newborn assessment according to Apgar scale.

Results. In the main group, the cause of primary hypothyroidism was as follows: newly diagnosed SHT – in 18 (48.6 %), AIT – in 7 (18.9 %) pregnant women. In the first trimester of pregnancy, TSH level in patients with hypothyroidism was 3.06 ± 0.36 mU/L. The following complications of pregnancy and childbirth course were identified: GDM (32.0 %), anemia of the first degree (12.0 %), large fetus (12.0 %), PROM (12.0 %), perineal rupture of the first degree (16.0 %), anomalies of labor activity with ineffective labor stimulation (8.0 %), pelvic-head disproportion (8.0 %).

Conclusion. Timely diagnosis and compensation of hypothyroidism with hormone replacement therapy and iodine preparations, prediction of possible complications and correction of identified complications are the main ways to achieve a successful outcome of pregnancy and childbirth for mother and fetus.

Aim: to asses an opportunity for predicting an unfavorable perinatal and maternal pregnancy outcome in severe novel coronavirus infection (NCI) COVID-19.  

Materials and Methods. A retrospective comparative study of the course and outcomes of pregnancies was performed in 40 patients with a gestational age of 22–42 weeks who had severe and extremely severe COVID-19 in 2021. The main group included 21 cases with an extremely severe course of the disease resulting in maternal mortality; the comparison group consisted of 19 patients with severe COVID-19 who successfully completed pregnancy. The diagnosis of NCI COVID-19 was confirmed in all cases by identifying SARS-CoV-2 RNA by polymerase chain reaction in a nasopharyngeal swab. During the study, all patients (during hospitalization, at the peak of the disease and before death/discharge from the hospital) underwent a comprehensive anamnestic, clinical and laboratory-instrumental examination. There were analyzed clinical blood test, biochemical parameters – lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase, creatinine, glucose, total bilirubin, total protein; coagulation parameters – prothrombin level according to Quick and fibrinogen, activated partial thromboplastin time, international normalized ratio; the level of C-reactive protein, procalcitonin, D-dimer, interleukin-6 (IL-6); ultrasound examination was performed during pregnancy (fetometry, placentometry), dopplerometry of uteroplacental blood flow and ultrasound of the pelvic organs, as well as pathomorphological placenta examination.  

Results. In patients who died from extremely severe NCI COVID-19 (main group), the course of the infection was accompanied by developing of respiratory distress (RD) degree III (χ2 = 12.84; p ≤ 0.05), and a progressive deterioration in mother's condition and/or fetal distress was an indication for emergency delivery by caesarean section (CS). The course of severe NCI COVID-19 in patients with a favorable outcome (comparison group), as a rule, was accompanied by the development of RD grade I and/or II; most of them were also delivered by CS on an emergency/urgent basis. Predictors of rapid progression of severe NCI COVID-19 in the main group were identified: subfebrile body temperature at the initial stages skewing to high fever during treatment instead of rapid temperature normalization (χ2 = 5.41; p ≤ 0.05; odds ratio (OR) = 5.0; 95 % confidence interval (CI) = 1.23–20.3); lack of leukocytosis at the initial stages (χ2 = 4.91; p ≤ 0.05; OR = 50; 95 % CI = 5.43–460.54) with rapidly increased leukocyte count with persistent stagnation in dynamics until death (χ2 = 19.79, p ≤ 0.05, OR = 50; 95 % CI = 5.43–460.54); severe lymphopenia (χ2 = 8.09; p ≤ 0.05; OR = 7.29; 95 % CI = 1.74–30.56), neutrophilia (χ2 = 10.17; p ≤ 0.05; OR = 10.29; 95 % CI = 2.21–47.84); high LDH values (χ2 = 17.99; p ≤ 0.05; OR = 31.88; 95 % CI = 5.09–199.49); increased IL-6 level at the peak of the disease (χ2 = 9.66; p ≤ 0.05; OR = 18; 95 % CI = 1.99–162.62) and in dynamics, as well as stably high D-dimer values (χ2 = 9.53, p ≤ 0.05; OR = 11.33; 95 % CI = 2.07–62.11).  

Conclusion. Significant changes observed in clinical and laboratory examination were identified, which reliably reflect the degree of patients' state, to be interpreted as predictors of adverse pregnancy outcomes during NCI COVID-19 and as a potentially justified serious reason for making a decision in the light of timely delivery aimed at a favorable outcome for mother and child. Timely delivery, carried out within the time limits for enabling adequate compensatory capabilities of the pregnant woman's body, demonstrates a rapid normalization of the main laboratory parameters. 

Introduction. Chronic pelvic pain negatively affects the quality of life (QoL) of patients with a painful form of external genital endometriosis (EGE) and adversely impacts on the physical, psychoemotional and sexual health of reproductive-age women resulting in distress, maladaptation, anxiety-depressive disorders, disrupted social functioning in family relationships. Aim: to assess the QoL of women with painful EGE after radical treatment in the rehabilitation period by using subjective research methods.  

Materials and Methods. We examined 104 female patients of reproductive age (42.4 ± 3.7 years) with painful EGE after radical treatment: group IA – 49 women underwent "active" rehabilitation, group IB – 55 patients underwent "passive" rehabilitation tactics in accordance with standards and National Clinical Guidelines. The assessment of QoL (subjective) was performed using specialized questionnaires: visual analog scale (VAS), PainDETECT questionnaire, Endometriosis Health Profile-30 (EHP-30) questionnaire, Hospital Anxiety and Depression Scale (HADS), Female Sexual Function Index (FSFI). Assessment of QoL parameters was carried out at 6 control time points: before, as well as 5–9 days, 1, 3, 6 and 12 months after surgical treatment.  

Results. Patients underwent "active" rehabilitation tactics (group IA) showed prominently reduced pain syndrome, neuropathic component of pain, anxiety-depressive disorders, normalized sexual function and improved all QoL parameters, unlike patients managed with "passive" tactics, who underwent a complex of rehabilitation measures within the framework of National Clinical Guidelines (group IB). More severe EGE course and significantly decreased QoL in patients with painful EGE at "passive" rehabilitation tactics were noted.  

Conclusion. Applying a complex personalized rehabilitation program along with multidisciplinary approach in patients with painful EGE after radical treatment can markedly improve overall well-being, timely correct psychoemotional and sexual dysfunction, and therefore prominently increase the patients' QoL. 

Aim: to estimate the rate of early-onset and late-onset fetal growth restriction (FGR) in stillbirth, identify features of placentaassociated complications and determine respective risk factors of stillbirth (especially at early gestational age).

Materials and Methods. There were retrospectively studied 61 stillbirth cases in 2016–2019 that occurred in the III level obstetric hospitals: 32 early (23–31 weeks of gestation) and late (32–39 weeks) cases; 156 live births with 8–10 Apgar scores delivered at 36–41 weeks of gestation used as controls. Quantitative parameters were compared using the mean values and standard deviation; nominal parameters were analyzed using odds ratio (OR) and adjusted OR (aOR) with 95 % confidence interval (CI).

Results. More than half of stillbirths are associated with FGR with almost 60 % of early-onset phenotype of this pathology. Both in stillbirths and live births, 2/3 of FGR have extremely low weight (OR = 1.8; 95 % CI = 0.6–6.9); 1/3 of growth restricted fetuses were detected shortly before delivery (OR = 1.3; 95 % CI = 0.7–2.4); 1/4 of pregnancies complicated by placental insufficiency are not associated with FGR (OR = 1.4; 95 % CI = 0.7–2.7). Risk factors of stillbirth in pregnancy complicated by FGR are the early-onset growth restriction phenotype (aOR = 3.2; 95 % CI = 1.0–10.3), maternal age over 28 years (aOR = 6.0; 95 % CI = 1.2–29.4), miscarriages and multiple induced abortions (aOR = 3.6; 95 % CI = 1.1–11.2), non-compliance in regular clinics visiting and correction of threatening conditions (aOR = 10.9; 95 % CI = 1.3–91.6), toxoplasma infection (aOR = 6.0; 95 % CI = 1.5–24.5). Early stillbirth with FGR is associated with an older mother's age (aOR = 5.8; 95 % CI = 1.0–34.4), greater parity (aOR = 3.3; 95 % CI = 1.0–10.4), uterine diseases including endometrial polyps, endometriosis, cervix cervicitis, cervix dysplasia (aOR = 4.0; 95 % CI = 0.9–17.2), diabetes mellitus (aOR = 3.1; 95 % CI = 0.8–13.2) and preeclampsia.

Conclusion. The rate of early-onset FGR in stillbirth comprises almost 60 % that is twice higher than in live birth, with the rate of late-onset phenotype being less than 30 %. In late stillbirths the early-onset phenotype also prevails. There are no prominent features for stillbirths with FGR compared to previously known risk factors regardless of hypotrophy. Early vs. late stillbirth with FGR is more associated with gynecological pathologies as well as with diabetes mellitus and preeclampsia.

Introduction. Due to the rapidly current reproductive technologies developing in recent years, much attention has been paid to patients who suffered from infertility (up to 55 %) mainly caused by chronic endometritis (CE). Due to the lack of prominent and specific clinical manifestations, laborious microscopic examination necessary for diagnostics, CE often receives no proper clinical attention. However, the undeniable relationship between CE and conditions associated with infertility such as repeated unsuccessful implantations and habitual miscarriage, dictates a need to expand knowledge about etiology and pathogenesis of this pathology in order to develop both highly informative diagnostic methods and create effective therapeutic regimens.  

Aim: to analyze the literature data on CE pathogenetic mechanisms.  

Materials and Methods. The available publications were searched in the databases Web of Science, eLIBRARY, Scopus, PubMed/MEDLINE released within the 1995–2022 period aimed at assessing CE pathogenetic and morphological features using query "chronic endometritis", "plasmocellular endometritis", "endometrial receptivity", "primary infertility", "secondary infertility", "implantation window". To avoid omission of suitable articles, a methodological filter was not applied. There were included full-text sources and literary reviews on the subject under study. Articles directly unrelated to CE topic were excluded from the review. In order to avoid inclusion of duplicate publications in the literature review if two studies by the same authors were found, the study period of each author was examined, and if the dates of publication coincided, most recent publication were used.  

Results. New morphological, immunohistochemical, genetic and immunological aspects of СЕ were summarized. The presence of plasma cells is the "gold standard" for CE morphological diagnostics, but their similarity to fibroblasts complicates histological examination and requires using expanded range of diagnostic markers. Thus, in CE patients, were identified a reduced expression of NK cells, with increased level of CD3+, CD+8, CD20+, CD138+ cells as well as pro-inflammatory factors, such as tumor necrosis factor-α – by 3-fold, interleukin-6 – by 2.7-fold, interleukin-8 – by 1.2-fold, interferon-γ – by 1.4-fold compared to healthy women. Special attention is paid to the features of hormone receptor network in chronic endometrial inflammation regarding reproductive losses in infertile women, while a favorable marker for successful pregnancy turned out to be the ratio of progesterone and estrogen receptors ranging from 2 to 3.  

Conclusion. Thus, CE rate in the pattern of the causes of infertility and unfavorable reproductive outcomes can up to reach 50 %, however, due to the difficulties of morphological diagnostics, verification of this diagnosis is complicated. The wide range of pathogenetic features of developing chronic inflammation in the endometrium highlighted here may be promising not only for identification of diagnostic markers, but also forimproving endometrialregenerative ability,whichwill increase odds for successfully executed reproductive function in infertile women. 

Advances in biology have allowed us to substantially deepen our knowledge about hemostasis functioning both in health and disease. ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) and von Willebrand factor (vWF) are components of the hemostasis system, which physiological interaction holds an important place in maintaining homeostasis. ADAMTS-13 is a metalloproteinase mainly acting to release vWF fragments into the blood plasma, as well as regulating its activity by cleaving ultra-large vWF multimers (UL-vWF) into smaller and less active forms. The study of such factors is of great clinical importance, since a decrease in ADAMTS-13 activity and an increase in vWF level can be predictors of microcirculatory disorders that play an important role in developing multiple organ failure. However, very few and fully contradictory studies devoted to the physiological aspects of the ADAMTS-13/vWF axis functioning in the mother–fetus system are available, therefore requiring to be further investigated.

Reproductive behavior is a complex related to a system of actions and attitudes taken by a man and a woman regarding the process of conception, bearing and giving birth to children, including planning practices, as well as methods of control. Currently, there is a downward trend in the birth rate, with the percentage of infertile couples being increased, despite the development of reproductive medicine and demographic policy. National programs are aimed at increasing the spread of family planning methods and reducing the number of child marriages. In addition to deep behavioral changes predetermined by the historical, social, economic, cultural and moral situation of an individual and society as a whole, the changes in the birth rate are based on adaptive mechanisms during sexual selection. In particular, a substantial research has focused on identifying additional biomarkers of male fertility in seminal plasma. There have been proven to exist differences in their absolute and relative levels between fertile men and men classified as infertile, based on sperm parameters of the World Health Organization. Studies dating back to the 1920s suggested a multifaceted role for seminal fluid in the reproductive process. It has been established that the paternal biological contribution to pregnancy and related ability to influence the reproductive outcome goes beyond simple provision of male gametes at conception. A new paradigm is emerging detailing an importance of communication between father and mother during gestation as it is associated with maternal tolerance to fetal antigens and, ultimately, pregnancy success.

Here, we describe the historical aspects of the life and scientific work of Maurice Arthus as well as his contribution to medicine.

Here, we describe the historical aspects of the life and scientific work of Paul Morawitz as well as his contribution to medicine.

In 2022, A.D. Makatsariya, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, was
recognized as the Best Author of the Sechenov University. The diploma and the award were solemnly presented by P.V. Glybochko,
Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Rector of the Sechenov University.