Ukrainian Journal «Health of Woman»

The role of melatonin in the implementation of women's reproductive plans: from menarche to the physiological course of the gestational process (literature review)

Yu.M. Duka — 2025-03-05

The indoleamine hormone melatonin, with its many physiological and biological functions, is now considered an important and essential hormone during pregnancy. Melatonin is an antioxidant, anti-inflammatory agent, free radical scavenger, circadian rhythm regulator, and sleep hormone.

Aim: to analyze the current data on the effect of melatonin on reproductive function, pregnancy and fetal development, and the issues of exogenous melatonin administration in obstetrics and gynaecology.

Recent studies have shown that the placenta can synthesize its melatonin, which acts as an antioxidant and anti-inflammatory agent, providing a stable environment for both mother and fetus. Thanks to its antioxidant properties, the integrity of the placenta is maintained. During physiological pregnancy, the mother's immune system is constantly changing, and melatonin acts as a key anti-inflammatory factor that regulates immune homeostasis in the early and late stages of pregnancy. Excessive production of oxygen and nitrogen metabolites are important mediators of cell and tissue damage. It is melatonin, which is easily transferred from the maternal circulation to the fetus, that may be a protective factor that will prevent free radical damage to the fetus and contribute to better perinatal outcomes. The antioxidant properties of melatonin have been shown to optimize the reproductive physiology of pregnant women by eliminating undesirable oxidative and nitrosative reactions in ovarian, uterine, and placental cells. It is emphasized that melatonin is an important factor for the course of early pregnancy, for the normal development and functioning of the placenta. It has been determined that the circadian release of this hormone is involved in the correction of various pathological conditions that occur during pregnancy: dyssomnia, pre-eclampsia, paroxysmal eclampsia. It has been shown that exogenous melatonin supplementation in pregnant women contributes to the regression of sleep disorders, pre-eclampsia, fetal growth retardation, and normalization of adrenal corticosterone levels.

No conflict of interests was declared by the authors.

Some aspects of the pathogenesis of placenta accreta spectrum (PAS): pathohistology, molecular mechanisms and biomarkers (literature review)

N.V. Gerevich — 2025-03-05

Aim - to study the current state of the pathogenesis of abnormal placental invasion, existing scientific research and potential future ways of predicting and screening for abnormal placental invasion in pregnant women.

To identify relevant information on placenta accreta spectrum (PAS) for the review, a database of modern scientific literature (2014–2024) was analyzed namely, from such scientific-metric databases as Scopus, PubMed, Google Scholar and the Web of Science databases. This review is to analyze the current literature on the molecular mechanisms and pathological signaling pathways associated with PAS. We assessed the state of the available data on the role of some proteins, chemokines and other biomarkers of trophoblastic invasion. In addition, we reviewed the data on the participation of epigenetic modifications and genes in key regulatory processes of trophoblastic invasion, including apoptosis, cell proliferation, invasion and inflammation.

Conclusion: Investigation of signaling pathways involved in the pathogenesis of PAS may provide valuable tools for the development of targeted therapies. Therapeutic strategies targeting these pathways may potentially inhibit abnormal placental invasion and angiogenesis.

The authors declare no conflict of interest.

Management of recurrent HPV-associated cervical intraepithelial neoplasias in women of perimenopausal age

T.G. Laskava — 2025-03-05

Aim: to increase the effectiveness of complex therapy of recurrence of cervical intraepithelial neoplasia (CIN) in women of perimenopausal age by optimizing management and postoperative rehabilitation.

Materials and methods. A prospective study of 60 Human papillomavirus (HPV) positive women of perimenopausal age with morphologically verified recurrent CIN II was carried out. Patients of the Group I (n=30) after radiowave conization of the cervix transvaginally used suppositories with ingredients of natural origin - centella asiatica, calendula, aloe, tea tree essential oil, hyaluronic acid, orally - a blend of extracts of herbs of Deschampsia caespitosa L., Calamagrostis epigejos, Echinacea purpurea. Patients of the Group II (n=30) received vaginal suppositories with methyluracil in the postoperative period.

Results. Cervical reepithelialization after the use of optimized management tactics was diagnosed in 100% of women, which occurred 1.3 times faster than in patients receiving traditional treatment. After 12 months from the start of treatment, the absence of multiple HPV infection and clinically significant viral load were determined, total elimination of the HPV in 96.7% of patients who received an optimized treatment complex.

Conclusions. Radiowave therapy in combination with a blend of plant extracts and ingredients of natural origin for topical use has anti-inflammatory, immunomodulatory, antiviral, and reparative effects, prevents the occurrence of postoperative complications, has adequate safety and tolerability.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent was obtained from all patients.

No conflict of interests was declared by the authors.

Рostoperative scar endometriosis: relevance of the present time

D.O. Govsіeіev — 2025-03-05

Рostoperative scar endometriosis (РSE) is extragenital endometriosis, develops in 0.03-1.5% of women after surgical interventions.

Aim - studying the problem of РSE and evaluating the tactics of managing this pathology in women for 5 years to improve and implement comprehensive treatment.

Materials and methods. An analysis of anamnestic and clinical data, examination and treatment of 46 women with РSE was carried out during 2020-2024.

Results. There was a 5-fold increase in the frequency of РSE from 2020 to 2024. Tumor-like formation was observed in the scar area in 46 (100%) women, pain in the scar area in 42 (91.3%) women; scar induration in 20 (43.5%) women; abnormal uterine bleeding in 11 (23.9%) women. 21 (45.7%) women with РSE had a hereditary predisposition; a high infectious index in 42 (91.3%) women and concomitant extragenital pathology in 17 (36.9%) women. 32 (69.6%) women had a history of artificial abortions, 7 (15.2%) had spontaneous abortions (electrovacuum aspiration 48.3%); 43 (93.4%) had a cesarean section. Among gynecological diseases: inflammation of the uterus and appendages in 19 (41.3%); cervical pathology in 15 (32.6%); infertility II in 8 (17.3%); appendage operations in 12 (26%) women. Clinical symptoms appeared after previous operations on average 3.2 years. 60.9% of women with РSE were operated on 2-4 years after the onset of complaints, which indicates untimely referral to a medical institution and late diagnosis. In 37% of women, the level of the tumor marker CA 125 is elevated (38.4 U/ml). The complexity of the operation depended on the duration of the appearance of РSE by the time of surgery. The longer the clinical manifestations of РSE, the more widespread the pathological process, which required the involvement of surgeons and urologists.

Conclusions. Predictors of РSE were identified: intrauterine operations, complicated heredity, chronic inflammation of the uterus and appendages, cervical pathology, induced abortions. A woman after surgery and histological confirmation of endometriosis of the scar requires observation by a gynecologist and therapy to prevent relapse.

The study was conducted in accordance with principles of the Declaration of Helsinki. Research protocol was approved by local ethics committee of the participating institution. Informed consent was obtained.

The authors declare no conflict of interest.

Optimization of general anesthesia for cesarean section

A.А. Padalko — 2025-03-05

The aim is to compare the effectiveness of the "routine" technique of total intravenous anesthesia with artificial lung ventilation during elective cesarean section and low-opioid multimodal general anesthesia.

Materials and methods. A prospective single-center open randomized cohort study was conducted, in which 60 clinical cases were analyzed. Patients were randomly divided into two groups of 30 people each: the first group received the "routine" technique of total intravenous anesthesia with artificial lung ventilation, the second - low-opioid multimodal general anesthesia with reduced intraoperative doses of fentanyl and sodium thiopental, as well as the addition of continuous intravenous infusion of lidocaine after childbirth. Additionally, the bispectral index and plasma levels of stress-induced substances (glucose and cortisol) were assessed. Newborns were assessed on the Apgar scale, the gas composition of umbilical venous blood, the dosage of anesthetic drugs and the course of the perioperative period.

Results. Analysis of the study results revealed statistically proven benefits of low-opioid multimodal general anesthesia: better mean arterial pressure, heart rate, and bispectral index, higher Apgar scores of newborns, better acid-base status of umbilical venous blood, lower glucose and cortisol levels, which resulted in faster recovery after surgery, shorter ICU stay, higher satisfaction with anesthesia, and lower pain.

Conclusions. Low-opioid multimodal general anesthesia with the addition of adjuvants (clonidine, acetaminophen, and lidocaine) during elective cesarean section has statistically proven advantages over the "routine" method of general anesthesia, by ensuring a satisfactory level of depth of anesthesia, hemodynamic stability, and a decrease in the body's stress response, which contributes to faster rehabilitation of patients after surgery and does not have a negative impact on newborns.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

The authors declare that there is no conflict of interest.

Markers of epithelial-mesenchymal transformation in the placenta and amniotic membranes by chorioamnionitis

K.V. Tymoshchuk — 2025-03-05

Premature rupture of membranes (PROM) is a significant problem in obstetric practice, causing significant complications for both the mother and the fetus.

Aim - to study the prevalence of markers of epithelial-mesenchymal transformation (EMT) in placentas from women with PROM depending on the level of glucose in the amniotic fluid and gestational age.

Materials and methods. A study was conducted on the placentas of 40 women, which, depending on the gestational age and the determined amniotic glucose concentration, were divided into groups: I group - 10 placentas from births at 24-37 weeks against the background of amniotic glucose concentration <0.5 mmol/l, II group - 10 placentas from births at 24-37 weeks by amniotic glucose concentration ≥0.5 mmol/l, III group - 10 placentas from term births with amniotic glucose concentration <0.5 mmol/l, IV group - 10 placentas from term by amniotic glucose concentration ≥0.5 mmol/l. In all placentas the content of vimentin and cytokeratin in the amnion and decidual membrane was determined by immunohistochemical method.

Results. In the II group cytokeratin expression was 0.178±0.006 c.u., which was significantly higher compared to the I group (0.156±0.007 c.u), in full-term pregnancies - 0.186±0.007 c.u and 0.138±0.005 c.u in the III group and the IV group respectively. In the I group vimentin expression was 0.267±0.004 c.u, but in the I group decreased to 0.178±0.003 c.u, in full-term pregnancies vimentin was also lower in the III group (0.138±0.006 c.u) compared to the IV group (0.207±0.005 c.u). This pattern indicates that low glucose levels suppress mesenchymal activity of chorionic villus cells

Conclusions. Chorioamnionitis as a complication of PROM is accompanied by significant structural rearrangements of placental tissues and amniotic membranes, which is manifested by a decrease in the expression of cytokeratin (a marker of epithelial cells) and an increase in the level of vimentin (a mesenchymal marker). This indicates a weakening of epithelial properties and activation of mesenchymal transformation. A clear dependence of the level of cytokeratin and vimentin expression on the glucose concentration in the amniotic fluid and gestational age was revealed: in the groups with low glucose levels (<0.5 mmol/l) a significant decrease in cytokeratin was observed, indicating a loss of epithelial cell integrity. An increase in vimentin levels at low glucose levels is associated with EMT activation, structural destabilization of membranes and an increased risk of their rupture.

The authors declare no conflict of interest.

Adipokine status in pregnant women with irritable bowel syndrome

L.M. Kupchik — 2025-03-05

Irritable bowel syndrome (IBS) refers to the disease whose course may be complicated with the onset of pregnancy due to physiological metabolic and adaptive changes to it. The study of concentrations of adipose tissue hormones - adipokines - may be useful for predicting the course of pregnancy and complications in women with IBS.

Aim - to study the anamnesis and course of pregnancy in IBS women.

Materials and methods. 154 women were examined (124 pregnant women from the study group, divided into 2 subgroups depending on the symptomatic/asymptomatic course of IBS; as well as 30 somatically healthy pregnant women from the control group) for anamnestic peculiarities and serum concentrations of chemerin, apelin and resistin. Statistical analysis and presentation of the results were done using the packages "MedStat" and "Microsoft Office Excel". The difference between groups was considered significant at p≤0.05.

Results. During pregnancy an increase in the concentrations of serum pro-inflammatory adipokines is observed, which is a risk factor for exacerbations of IBS. Symptomatic course of IBS is observed in women with significantly higher concentrations of serum adipokines, risk of gestoses (preeclampsia, vomiting of pregnancy), gestational diabetes mellitus and miscarriage are also increased in these women.

Conclusions. Serum concentrations of apelin, chemerin, and resistin in pregnant women can be used as markers predicting the symptomatic course of IBS and IBS itself also contributes to named adipokines elevation, which leads to higher pregnancy complications risk.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the participating institution. Informed consent of the patients was obtained for the study.

The authors declare no conflict of interest.

Сhorioamnionitis and preterm birth: a retrospective study

O.B. Yaroshchuk — 2025-03-05

Aim - to determine the frequency of clinical (CCA) and subclinical (histological) chorioamnionitis (SCA) in patients with preterm birth (PTB) and to analyze their association with gestational age and pregnancy outcomes, in order to improve early diagnosis, risk stratification, and prevention of PTB associated with intraamniotic inflammation.

Materials and methods. This retrospective study included cases of PTB from 2022 to 2024. A total of 15,760 charts of pregnant women were analyzed, from which 562 (3.5%) cases with PTB were identified (out of 562, 210 (37%) pregnant women were diagnosed with SCA). Patients were divided into three groups based on gestational age: the Group 1 (22-27 weeks) - 42 patients, the Group 2 (28-34 weeks) - 187 patients and the Group 3 (35-37 weeks) - 333 patients. The presence of chorioamnionitis was determined based on histological and clinical data. The study analyzed the structure and causes of PTB as well as birth outcomes.

Results. A significant association was found between SCA and PTB, particularly in the early gestational group (22-27 weeks), where SCA was present in 73% of cases.

Conclusions. SCA is a common and important cause of PTB, especially at earlier gestational ages. It is mainly diagnosed through histological examination of the placenta. A strong association exists between SCA and adverse labor outcomes. A multifactorial approach is required for the prediction and prevention of PTB related to intraamniotic inflammation.

No conflict of interests was declared by the authors.

Influence of vitamin D levels on fertilization rate and pregnancy after in vitro fertilization: a retrospective analysis

O.O. Kyrylchuk — 2025-03-05

Currently, vitamin D deficiency is associated with an increased risk of abnormal pregnancy implantation, leading to obstetric complications such as preeclampsia and fetal growth restriction. However, the effect of vitamin D on infertility treatment outcomes in couples using assisted reproductive technologies (ART) remains poorly studied.

Aim - to determine whether vitamin D is associated with clinical outcomes of in vitro fertilization (IVF), specifically to examine the relationship between preconception serum vitamin D level and pregnancy outcomes following ART in women with infertility.

Materials and methods. The study was conducted from September 2023 to September 2024. A total of 100 patients selected for the study had their vitamin D level measured before undergoing ART. All participants were divided into three groups based on their total vitamin D levels: the Group 1 - 65 patients with vitamin D level deficiency (<50 nmol/L); the Group 2 - 24 patients with insufficient vitamin D level (50-75 nmol/L); the Group 3 - 11 patients with optimal vitamin D level (>75 nmol/L). Multivariate logistic regression was used to assess the predictors of ongoing pregnancy.

Results. The rates of ongoing pregnancy were as follows 53.8% (35/65) in the Group 1, 66.6% (16/24) in the Group 2, and 72.7% (8/11) in the Group 3. Women with optimal vitamin D level are more likely to conceive and achieve an ongoing pregnancy through IVF compared to those with vitamin D deficiency or insufficiency.

Conclusions. Vitamin D deficiency and insufficiency are common among women undergoing infertility treatment with ART. The approximate rate of ongoing pregnancy achieved in women receiving ART is associated with serum vitamin D levels and is higher in those with optimal vitamin D status.

The author declares no conflict of interest.

Endometrial pathology in postmenopausal women

Ya.V. Voskhulat — 2025-03-05

Vaginal bleeding is the most frequent clinical manifestation of intrauterine pathologies, they are observed in 12% of postmenopausal women and are the main reason for consulting a gynecologist.

Aim - to study the prevalence of gynecological pathology in postmenopausal women and to assess the impact of menopausal hormone therapy (MHT) in the anamnesis on the frequency of its occurrence.

Materials and methods. A retrospective analysis of medical records of 82 postmenopausal patients was conducted, who were divided into two groups: those who received MHT during the menopausal transition (MHT+; n=41), and those who did not receive it (MHT-; n=41). Gynecological complaints, transvaginal ultrasound (TVUS) results, and histological findings from pipet biopsy or hysteroscopy were assessed. Statistical analysis was performed using the chi-square test.

Results. 55 (67,0%) patients had gynecological symptoms such as spotting or bleeding in postmenopause, postcoital bleeding, cramping pain in the lower abdomen, discomfort during intercourse, abnormal discharge, and vaginal dryness. According to TVUS, endometrial thickness of more than 5 mm was detected in 23 patients, and in 4 patients, additionally, multiple blood flow loci and endometrial heterogeneity were detected. According to the results of histological examination, atrophic endometrium and endometrial hyperplasia without atypia were most often detected in the both groups, and less often, endometrial polyps and atypical endometrial hyperplasia.

Conclusions. The most common ultrasound manifestation of endometrial pathology was endometrial hyperplasia, which was detected in 13 (31.7%) women in the MHT+ group and in 10 (24.4%) women in the MHT- group. The most frequent histological findings were atrophic endometrium (34.14% and 39.02%, respectively, in the MHT+ and MHT- groups) and endometrial hyperplasia without atypia (26.82% and 19.51%, respectively, in the MHT+ and MHT- groups), regardless of the history of MHT.

These results indicate the absence of the effect of menopausal hormone therapy on ultrasound and histological changes of the endometrium in postmenopause.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.

Identification and characterization of risk factors for miscarriage in women of the first trimester of gestation

N.A. Rynda-Dzuriy — 2025-03-05

Ultrasound examination plays a significant role in the diagnosis of threatened abortion. Changes in the structure of the myometrium, pathological ECHO inclusions, morphological changes in the appendages, shortening of the length of the cervix, opening of the internal os, deformation of the fetal egg, pathological localization of the chorion, the presence of retrochorial hematoma, impaired blood flow in the uterine arteries - the main ultrasound characteristics of the threat of abortion.

Aim - to optimize the prediction of miscarriage in women by identifying early risk factors.

Materials and methods. A prospective analysis of 94 pregnant women was conducted. The study included 59 pregnant women who, at the time of blood serum donation, were diagnosed with a threat of miscarriage and/or had a history of complicated pregnancy and childbirth. Anamnestic and biochemical data, ultrasound parameters were analyzed, and univariate and multivariate analysis of the risk of miscarriage was performed.

Results. Univariate analysis revealed a significant increase in the risk of miscarriage with the age of the woman, in the presence of retrochorial hematoma, chorion presentation or pathological attachment, the presence of uterine and adnexal formations and a significant decrease in the risk of miscarriage of vaginitis with an increase in the cervical length index. In univariate analysis, HSP60 and GroEl indicators do not play a role, although GroEL is on the verge of significance. In multivariate analysis, a significant increase in the risk of miscarriage with the presence of retrochorial hematoma, uterine and adnexal formations and a significant decrease in the risk of miscarriage with an increase in the cervical length index and the total number of births. The indicators of multivariate and univariate analysis differ significantly.

Conclusions. The study confirms that ultrasound examination plays an important role in the diagnosis of miscarriage. The presence of retrochorial hematoma, chorion presentation or pathological attachment, the presence of uterine and/or adnexa formations, and shortening of the length of the cervix are risk factors for miscarriage. The risks of miscarriage are associated with the age of the woman and the total number of births. Determination of heat shock protein levels can be taken into account in the complex and indirectly indicate the presence of a risk of miscarriage or a complicated course of pregnancy.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee. Informed consent for the study was obtained.

The authors declare no conflict of interest.

Gender peculiarities of sanitary and hygienic knowledge in youthful smokers

I.S. Lisetska — 2025-03-05

Adherence to proper oral hygiene is one of the most important factors influencing the formation of dental health in general and hard tooth and periodontal tissues in particular among different age groups, including young people.

Aim - to study the gender peculiarities of sanitary and hygienic knowledge among adolescents who use different types of smoking for further development of a scheme of treatment and prevention measures.

Materials and methods. The level of sanitary and hygienic knowledge and skills in young people was assessed using the traditional questionnaire method in 95 young people (18 to 24 years old) who smoke, who were divided into two groups: the main group - 48 female people, the comparison group - 47 male people.

Results. It was found that the majority of female respondents pay attention to the state of the oral cavity 1.2 times more often than male respondents (72.4±4.3% and 62.8±3.5%). Mostly female respondents visit a dentist every 6 months, which is 1.1 times more often compared to male respondents (60.4±4.1% and 55.7±3.5%). The remaining female respondents are 1.2 times more likely than male respondents to say that they regularly visit a dentist every 12 months - 34.8±2.6% and 28.5±2.1%, respectively. It has been found that female respondents are 1.3 times more likely to report regular care for individual oral hygiene compared to male respondents - 87.4±6.8% and 69.3±5.2%, respectively.

Conclusions. The analysis of the study results indicates gender peculiarities of sanitary and hygienic knowledge and skills, which indicate the need to develop and consolidate in young people, especially men, a positive attitude towards a healthy lifestyle and dental health.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Сommittee on bioethics and deontology of these institutions. Informed consent of the patients was obtained for the study.

No conflict of interests was declared by the authors.