Combined hormonal contraception is an effective method of preventing pregnancy and at the same time has a number of therapeutic effects. The need for contraception persists until the final cessation of menstrual function, but at an older fertile age, the selection of a hormonal agent becomes a daunting task. Over the past years, a woman has accumulated factors that can complicate the use of hormonal drugs, and, on the other hand, new problems arise in the transitional period of life, which combined contraceptives can solve. An equally relevant topic is the question of stopping the use of combined hormonal contraceptives and initiating menopausal hormone therapy. All of the above aspects of the use of hormonal drugs require deep understanding for the adequate management of women entering the final phase of reproductive life.

Endometriosis is a chronic disease with a pronounced psychosomatic component. Women with endometriosis have their own characteristic portrait. The article discusses modern ideas about endometriosis as a factor affecting a woman’s personality, her family relationships, the quality of her sleep, and, finally, communication with a doctor. The approaches to building a productive dialogue with patients with endometriosis, methods of increasing adherence to therapy, the advantages of oral contraception with dienogest in the treatment of endometriosis are examined in detail.

Premenstrual syndrome (PMS) is a common disease associated with a serious decrease in the quality of life of a woman, a violation of habitual life and working capacity. The etiology of PMS and premenstrual dysphoric disorder (PMDD) has not yet been established, but it is clear that their development is associated with fluctuations in hormone levels within the ovulatory menstrual cycle and impaired balance of neurohormones in the central nervous system (CNS). In connection with these ideas, in the treatment of PMS, two main directions are used: the suppression of hormonal fluctuations and the effect on the central nervous system. Among the large number of drugs claimed for the treatment of PMS and PMDD, the so-called alternative therapy deserves special attention, in which several methods have a worthy evidence base for positive effects.

Objective. To determine the effectiveness of alternative methods for assessing abortion using the drug method at an early date for use in the interests of patients.

The main provisions. 35 literary sources published in the MEDLINE, PubMed, and other databases were analyzed. It has been shown that the woman’s independent use of semi-quantitative or multi-level tests for determining the content of β-hCG in the urine at home, combined with telephone control by a physician, has high sensitivity and specificity in diagnosing pregnancy termination, is not inferior in terms of the effectiveness of ultrasound, and excludes the likelihood of overdiagnosis of abortion.

Conclusion. Routine clinical examination and ultrasonography are not required after medical abortion, and self-testing for β-hCG in the urine can be used to confirm the complete termination of pregnancy in the early stages.

Infections of the vulva and vagina remain one of the most pressing problems of modern gynecology due to the high prevalence, frequent relapses, and negative effects on the functions of the reproductive system, which increases the risks of gynecological diseases and obstetric complications. The most common forms of vulvovaginal infection are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AB) and trichomoniasis. Features of the biocenosis and immune status in infections caused by conditionally pathogenic microorganisms predispose to relapses of BV, AB, and VVK, against the background of which a mixed infection develops. Its occurrence is also the result of repeated courses of treatment for recurrent monoinfection. Therapy of BV consists in the use of metronidazole and clindamycin, the benefits of clindamycin are in a wider spectrum of action, covering difficult to identify anaerobic microorganisms, as well as aerobes. The treatment of mixed infection and the prevention of the development of IHC in patients with BV involves the use of azole antimycotics, which remain the first line treatment option for the infection caused by Candida albicans. Thus, the combination therapy with clindamycin and azole antimycotics can be considered the optimal treatment option for mixed and recurrent vulvovaginal infections.

The pathogenesis of placental insufficiency and other complications of gestation is associated with vascular endothelial dysfunction. Glycocalyx covering the endothelium plays a fundamental role in coagulation and fibrinolysis. The presence of low molecular weight glycosaminoglycans in glycocalyx has a protective effect. The proven clinical efficacy of sulodexide to correct vascular endothelial dysfunction, prevent placental insufficiency and other pregnancy complications makes it a promising tool for use in obstetric practice among patients with chronic diseases (arterial hypertension, diabetes, obesity, etc.), autoimmune pathology, thrombophilia and related pregnancy complications (gestational diabetes, hypertension in pregnant women, pre-eclampsia, recurrent miscarriage, fetal growth retardation).

Objective of research was to study the production of serum and placental cytokines and relaxin in women with a physiological pregnancy (45) and complicated by type I diabetes mellitus (42). The research material was the placenta and serum of pregnant women, in which determined the level of cytokines TNF-α, TGF-β, IL-1β and relaxin. It has been shown that the cytokine-producing function of the placenta plays an important role in the development of that organ, and systemic production of cytokines and relaxin is of key importance in the development of endothelial dysfunction syndrome. Early diagnosis of complications in pregnant women with type 1 diabetes will make it possible to start etiopathogenetic therapy in a timely manner and makes it possible to perform adequate obstetric tactics of labor.

A retrospective study of 76 pregnant HIV-positive women (main group) and 198 pregnant women without HIV infection (comparison group) with preterm birth and their newborns was conducted. In the main group, anemia, fetal growth retardation, meconium release into the amniotic fluid were most often recorded. Grade 1–2 cerebral ischemia was detected in 86.8 % of infants, respiratory failure in 7.9 %, while respiratory distress syndrome was prevented in 46 % of cases.

This clinical case report represents our experience of treatment of 36 y. o. pregnant female patient who was previously undergone mitral valve replacement as she was 25. The operation was performed with the use of two leaflet mechanical prosthesis ‘MedEng No. 21’ (Russia). The patient was admitted to our hospital at 29th week of gestation with the signs of heart failure and pulmonary congestion because of prosthetic valve dysfunction. Delivery was performed by Caesarean section followed by mitral valve reprosthetics. In order to stop obstetric bleeding before heparin injection internal iliac arteries was ligated. Total time of extracorporeal circulation was 89 minutes, and myocardial ischemia — 64 minutes. Normothermic perfusion was performed. Mother and newborn were discharged from the hospital in a normal stable state. The childbearing ability of the mother was preserved.