Optimization of the method of introducing an anti-adhesive barrier during laparoscopic operations allows surgeons to freely use an anti-adhesive barrier – «Аntiadhesin» – in their practice in order to prevent the occurrence of postoperative adhesions.

Target. To conduct a comparative study of various methods of local delivery of the anti-adhesion gel ‘Antiadgesin” to the abdominal and pelvic organs during laparoscopic interventions in gynecology.

Materials and methods of research. An analysis of 442 cases of laparoscopic operations, 90 cases of operations with laparotomic access and 180 hysteroscopic interventions was carried out, in which Antiadgesin was delivered to the wound surfaces using various conduction systems (applicators). The studies were conducted at the clinical base of the Department of Obstetrics and Gynecology No. 2 of the Stavropol State Medical University, in the department of operative gynecology from 2020 to 2023.

Results. In the course of the study, the effectiveness of using a disposable silicone conductor (applicator) 27 cm long, with an outer diameter of 4 mm and an internal diameter of 3 mm, was established for targeted local delivery of anti-adhesive gel “Antiadgesin” to all hard-to-reach areas of the abdominal cavity and pelvis (including in obese patients). Local targeted delivery allows you to effectively use the volume of gel supplied in the syringe, covering all necessary wound surfaces.

The problem of non-developing pregnancy (NB) remains relevant due to the rather wide spread of this complication and is due to the search for prognostically significant causes of this pathology, the development of adequate prevention of the detected disorders [1–4]. Polymorphic variants of folate genes lead to excessive accumulation of HC in the blood and hypomethylation of DNA, which contributes to an increase in early miscarriage (the frequency of this pathology is 20–25% of all pregnancies). Carrying out periconceptional prophylaxis with high doses of folic acidreduces the level of free HC in the blood, but this technique is effective only when it begins 3 months before conception and in the early stages of embryo and fetus development (up to 12 weeks). The evaluation of laboratory and clinical data in the course of the study confirmed the effectiveness of the use of folic acid at a dose of 800 mcg in a high risk group for the development of NB (pregnant women with hyperhomocysteinemia (GHZ)) 16 weeks before conception and 12 weeks after conception.

Cervicitis is a clinical syndrome characterized by inflammation of the predominantly columnar epithelium located on the exocervix and/or inside the cervical canal. The cause of inflammation can be infections, including sexually transmitted infections (STIs), some systemic diseases, allergic reactions, chemical and mechanical irritants, and other factors. Chronic cervicitis is important from the point of view of oncological alertness, since it promotes deeper penetration of infectious agents into the tissue of the cervix, increases the risk of infection and persistence of the human papillomavirus (HPV). The article presents data on the diagnosis of cervicitis with an emphasis on cellular changes occurring in the cervical epithelium and patient management tactics.

The leading place among diseases of the female reproductive system is occupied by disorders of the vaginal microbiome, which lead to severe obstetric and gynecological pathology.

Background Study and analysis of the frequency of various variants of disorders of the vaginal microbiota.

Materials and methods. The follow-up included 595 patients who complained of copious discharge from the genital tract. The diagnosis was established on the basis of complaints, objective examination data, pH-metry results, microscopic examination, PCR analysis (Femoflor 16) in real time.

Results. Complaints of copious discharge from the genital tract were detected in 595 patients (100%). Unpleasant odor – 470 people (78.99%); discomfort during sexual intercourse – 321 people (53.95%); itching in the area of the external genitalia 195 (32.77%) people; burning, pain during urination 121 (20.33%). Microscopy of Gram-stained smears revealed an increased white blood cell count in 367 people (61.68%), without leukocytosis in 228 people (38.31%); trichomonas were found in 46 people (7.73%), candida in 195 (32.77%).

Conclusions. Thus, when patients complain of copious discharge, a violation of the balance of the vaginal microbiota is revealed. pH-metry indicates the presence of dysbiosis, PCR diagnostics allows you to identify a variant of dysbiosis or the presence of infection, which allows you to start pathogenetic treatment in a timely manner.

Relevance. Morphological analysis of the nervous regulation of the functioning of internal organs forms the basis of Russian neurohistology. In addition to the study of the structural and functional organization of the autonomic nervous system (ANS) in adulthood, special attention is paid to the study of ganglion apparatus and the formation of innervation relationships in embryological development, since it is during this period that the foundations of both the normal functioning of all organs and the possible appearance of pathologies in adulthood are formed [1]. To date, extensive material has been accumulated on various aspects of the structural and functional organization of most departments of the internal medicine at different stages of ontogenesis. Of particular interest in recent years is the relationship between the nervous and endocrine systems, as the main regulatory systems of the body, functioning in constant mutual regulation, starting from the moment of their embryonic development. Most of the information about the innervation of the reproductive system in humans has been obtained by methods of classical neurohistology, the development of this department of the ANS during the prenatal period remains less studied. There are only few ultrastructural and histochemical data on the embryonic development of gonad innervation in human embryos, mainly in the second half of the prenatal period. The nervous control of the activity of the gonads determines the endocrine status of the body and has a significant effect on the development of germ cells. Endocrine influences are important factors determining the structural and mediator phenotype of developing neural derivatives of the neural crest. A comparative analysis of the formation of the innervation apparatus of the female and male genital glands in embryogenesis is of considerable interest, since this allows us to clarify the relationship between the influence of different hormones on the development of the nervous apparatus of these organs.

Purpose. The aim of the work was to analyze the development of the nervous system of the female and male human reproductive system during embryonic development. To achieve this goal, the following tasks were set: to study electron microscopically the development of the ganglion apparatus of the genital organs in female and male fetuses in embryogenesis; histochemically and electron microscopically investigate the innervation of the ovaries and testes in the prenatal period of ontogenesis; to conduct a comparative analysis of the development of the ganglion conduction parts of the nervous apparatus of the ovaries and in human embryos. During the research, the following data were obtained: the dynamics of embryonic differentiation of neurons and glial cells, as well as intermalignant relationships in the genitals, were found; the presence of a transitional «adrenergic» phase in the development of neuronal precursors of neurons in the genital ganglion apparatus has been established; small granular cells were not found in the nerve ganglia of the genital organs of human fetuses; electron microscopically showed the presence of nerve fibers in the ovaries and testes in 7-week-old embryos histochemically adrenergic nerve terminals were detected at the 12th week of prenatal development; connections of nerve endings with developing ovarian follicles and forming spiral testes have been investigated; in human spermatozoa, starting from the age of 7 weeks, the presence of a large number of large intermediate Leydig cells with a well-developed smooth endoplasmic reticulum was detected.

Materials and methods. The study was conducted on the material presented by human embryos of both sexes, whose age ranged from 6 to 22 weeks. The embryos were obtained from the gynecological department of the 4th City Clinical Hospital in Saransk. The age of the samples was determined based on obstetric data, weight, body length from crown to coccyx and length from crown to heel. The objects of the study were the organs of the reproductive apparatus: uterus, fallopian tubes, ovaries, seminal tubules, as well as the nerve plexuses surrounding them. The process of fixing the samples began no later than 30 minutes after the surgical intervention performed to terminate the pregnancy. The main research methods used in the article are the standard research method, the methods of classical neurohistology, the electron-histochemical method, the methods of J.P. Transer and G. Richards, the method of V.N. Shvalev.

Results and conclusions. When analyzing the data obtained based on the results of the study, it was revealed that the neural derivatives of the neural crest are determined in the pelvis in the early stages of embryonic development.

Relevance. Premenstrual syndrome (PMS) is an urgent gynecological problem. Timely diagnosis and treatment are necessary to ensure a normal quality of life for patients.

Aim. To improve the results of treatment of severe pain manifestations and disorders of the antinociceptive system in women with premenstrual syndrome (PMS) based on the identified pathogenetic mechanisms.

Materials and methods. 158 women of reproductive age were examined. The women were divided into two groups: the main group consisted of 70 women (with clinical manifestations of PMS) and the control group included 88 women of reproductive age with no complaints and a regular menstrual cycle.

Conclusion. The article analyzes modern ideas about the pathogenesis of PMS, and also demonstrates the severity of algic manifestations in women suffering from premenstrual syndrome. 

External genital endometriosis is characterized by the spread of the endometrium beyond the uterine cavity with damage to the pelvic peritoneum, ovaries, fallopian tubes, and ligaments. This endometriotic tissue undergoes the same cyclic changes as normal endometrium, and symptoms correspond to pathological conditions of the menstrual cycle. The study of biochemical parameters allows us to identify the disease and assess the level of its development. The aim of the work is to study the degree of changes in the level of anti-inflammatory and pro-inflammatory cytokines in serum and peritoneal fluid in patients with external genital endometriosis. The main methods for assessing the level of cytokines include immunoassay methods: ELISA (Enzyme-Linked Immunosorbent Assay) or Luminex analysis. Inflammation is a clear sign of the formation of endometriosis. Studies have shown that increased serum levels of transforming growth factor β1, tumor necrosis factor α, interleukin 1β, high-density lipoprotein, and nitric monoxide (NO) metabolites are observed in women with stage I–II external genital endometriosis. In patients with stages III–IV of disease, an increase in cholesterol, low- and high-density lipoproteins was observed in the peritoneal fluid. A relationship was found between the level of high-density lipoproteins and tumor necrosis factor α (its content increases twofold), indicators of transforming growth factor beta and metabolites of nitrogen compounds. High levels of tumor necrosis factor α can be considered in presents of infection. High levels of transforming growth factor β1 are considered as markers for stage III–IV external genital endometriosis, and in the future the development of fibrosis.

The influence of malignant neoplasms and their treatment methods on the reproductive function of women is one of the significant problems of oncogynecology. The mechanisms of ovarian follicle loss caused by chemotherapy have their own characteristics depending on the characteristics of the cytotoxic agent and act differently on different populations of ovarian cells. The toxic effect on fertility of the main groups of antitumor drugs is considered. Reproductive dysfunction has negative consequences for a woman’s physical and mental health. The use of methods that reduce the effect of cytotoxic agents on the ovary helps to prevent premature ovarian insufficiency, leading to infertility. The article discusses modern methods of fertility preservation using assisted reproductive technologies. All cancer patients of reproductive age should receive full oncofertility counseling as early as possible, during the treatment planning process, regardless of the type and stage of the disease.

We retrospectively analyzed 148 cases of new coronavirus infection in pregnant women in the second half of pregnancy between May 2020 and December 2021. Groups were divided according to gestational age: comparison group I (n=104) – deliveries from 37 weeks and over, term; main group II (n=44) – deliveries from 22 to 36+6 weeks preterm. Among pregnancy complications, women in the preterm labour group were 6.5 times more likely to have moderate anaemia than those in the term labour group (95% CI: 1.2–35.1). Severe pneumonia and its progression associated with SARS-CoV‑2 infection was the main indication for premature delivery. Consequently, the odds of caesarean section were 12.6 times higher (95% CI: 4.2–37.8) in the preterm labour group than in the on-time delivery group. Of these, the proportion of emergency caesarean section was 100% (44) (χ2 =3.61; p=0.13). Postpartum endometritis was 13.2 times more frequent in women in the preterm labour group than in the term labour group (95% CI: 1.4–11.6). Cases of sepsis in the postpartum period were recorded only in the preterm labour group – 6.8% (n=3), p<0,05. Newborns in the preterm labour group had lower birth weight and Apgar scores, which was primarily due to prematurity and required respiratory support and longer hospital treatment. In the preterm group, the odds of neonatal malformations were 4.6 times higher than in the term group (95% CI: 1.75–12.90). The new coronavirus infection in the absence of infection in the placenta was detected in one case 2.3% (n=1).

The combination of male and female infertility leads to infertility in 2/3 of cases. To date, it is considered that male infertility is clinically manifested as pathological changes in the spermogram. This article presents a clinical observation of a 40-year-old man who has not had children for 3 years, but in this case, the sperm data show normozoospermia. The results of physical examination and ultrasound of the scrotum did not reveal any pathological changes. A detailed examination of the patient revealed a DNA fragmentation of spermatozoa of more than 20%, which was difficult to correct with medication. The conclusion of the laboratory study of the ejaculate – «normozoospermia» is not always an indicator of the reproductive health of a particular patient. Infertile men with normozoospermia need an extended diagnosis, with the determination of DNA fragmentation of spermatozoa.

Human papillomavirus (HPV) is a common sexually transmitted infection and predominantly affects both female and male genitalia. Most HPV-associated infections are transient and asymptomatic, but in the presence of lesions with oncogenic HPV strains, they can lead to the development of cancer of the cervix, anus, penis, vagina and vulva. Women of reproductive age and adolescents are most susceptible to these diseases, and their cause may be excessive sexual activity with frequent changes of sexual partners and early onset of sexual activity. Due to the prevalence of this nosology in the population, as well as its complications in the form of oncological diseases, vaccine prophylaxis was developed, of the drugs registered in the Russian Federation, it is necessary to note recombinant quadrivalent and divalent vaccines against human papillomavirus, which can stimulate humoral immunity and the production of virus neutralizing antibodies, while reducing the number of new cases of infection and the number of cases.

The aim of the present study was to consider the human papillomavirus as a predictor of cervical cancer in women of reproductive age.

Results. Pathological changes in the cells of the cervix caused by the human papillomavirus (HPV) are one of the most common causes of the development of preinvasive changes in this area. Preinvasive changes in the cervix (CIN) are dysplastic changes in its epithelium that can progress to invasive cervical cancer if they are untimely diagnosed and treated. It is worth noting that most types of cervical cancer develop in the transformation zone – the junction between the squamous cells of the ectocervix and the columnar glandular cells of the endocervical canal. Early infection with HR-HPV infections can disrupt the metaplastic changes occurring at this time in the transformation zone and increase the risk of developing cervical cancer in the future. About 80–90% of cervical cancers are squamous cell carcinomas (SCC), 10–20% are adenocarcinomas, and the percentage of the latter has been increasing in recent years. Sometimes cervical cancer has signs of both types and is called adenosquamous or mixed carcinoma.

Conclusion. HPV infection is one of the most common sexually transmitted infections, which can cause the development of various diseases, including cervical cancer. In this regard, the development and implementation of vaccines against HPV infection is an important task in the field of public health, as they are able to stimulate humoral immunity and the production of virus neutralizing antibodies.