Ukrainian Journal «Health of Woman»

Women's screening: standards, recommendations, benefits

A.S. Biduchak — 2025-11-15

Women's health is a strategic indicator of the state of public health, demographic stability and socio-economic development of society. It determines not only fertility and life expectancy indicators, but also forms the basis for the sustainable development of the state and the well-being of future generations. Given the global trends of population aging, urbanization and lifestyle changes, the preventive focus of medical care is gaining priority. In the context of the growing prevalence of chronic non-communicable, oncological, endocrine, and metabolic diseases, preventive measures aimed at early detection of pathology are becoming particularly relevant. Women's health screening as a system of periodic examinations allows for the diagnosis of diseases at preclinical stages, reducing mortality and improving the quality of life. At the same time, the level of coverage of screening programs remains insufficient due to low awareness of the population, socio-economic barriers and organizational difficulties in the functioning of the healthcare system.

Aim - to analyze modern standards of female screening, summarize international and national recommendations for preventive examinations and determine their role in increasing the effectiveness of early diagnosis and reducing morbidity and mortality rates.

The study is analytical and review in nature. Scientific publications, clinical guidelines and regulatory documents for 2019-2025 were analyzed. Methods of systemic, comparative and general analysis were used, taking into account age characteristics, individual risk factors and the possibilities of adapting international standards to the national context. It was established that female screening covers oncological, cardiovascular and metabolic, gynecological, hormonal, osteoporotic, and infectious areas. Regular cytological and HPV testing, mammography, as well as monitoring of blood pressure, glycemia and lipid profile ensure timely detection of pathological changes and prevention of complications. For Ukraine, it is relevant to implement a risk-oriented comprehensive screening algorithm integrated into the primary health care system, with subsequent monitoring and increasing women's adherence to preventive examinations.

Conclusion. Women's screening is an effective prevention tool that requires improving organizational mechanisms, strengthening educational work and an individualized approach at different stages of a woman's life.

The authors declare no conflicts of interest.

Contemporary perspectives on the role of hormonal changes and extragenital diseases in women with infertility and in pregnant women using assisted reproductive technologies: a literature review

O.O. Kyrylchuk — 2025-11-15

Female infertility remains a significant problem in modern reproductive medicine and is increasingly recognized as a multifactorial condition. Growing evidence indicates that hormonal disturbances and concomitant extragenital diseases play an important role in impaired fertility and influence the outcomes of assisted reproductive technologies (ART).

Aim - to analyze current scientific data on the impact of hormonal alterations and extragenital pathology, particularly thyroid and breast disorders, on female fertility, pregnancy course, and ART effectiveness. A systematic analysis of domestic and international publications on infertility, endocrine disorders, autoimmune diseases, hormone-dependent mammary gland pathology, and their relationship with natural fertility and ART was conducted. Thyroid dysfunction, including subclinical forms and autoimmune thyroid disease, is associated with ovulatory disorders, reduced ovarian reserve, impaired oocyte quality, and an increased risk of adverse obstetric and perinatal outcomes. Controlled ovarian stimulation protocols used in ART may further disrupt thyroid homeostasis, highlighting the need for careful preconception screening and monitoring. Benign hormone-dependent breast diseases, especially fibroadenoma, are frequently observed in infertile women and may reflect underlying systemic hormonal imbalance. Although most available studies do not confirm a direct causal relationship between ART and breast cancer development, conflicting evidence persists, emphasizing the importance of individualized risk assessment. Overall, female infertility should be regarded not as an isolated reproductive disorder but as a manifestation of systemic hormonal and somatic dysregulation.

A comprehensive multidisciplinary approach, including early detection and management of extragenital diseases, may improve ART outcomes and optimize reproductive and perinatal results.

The authors declare no conflict of interest.

Antibacterial therapy in pregnancy complicated by pre-labour rupture of membranes

T.T. Narytnyk — 2025-11-15

Aim - to summarize current evidence on pre-labour rupture of membranes (PROM), with particular emphasis on the impact of gestational age on the choice of pregnancy management strategy and the appropriateness of antibacterial therapy, as well as to analyze the evolution of clinical guidelines in the context of the growing problem of antimicrobial resistance.

Рre-labour rupture of membranes remains one of the leading complications of pregnancy, associated with high perinatal morbidity and mortality, the incidence and outcomes of which largely depend on gestational age. The review addresses the contemporary classification of PROM, associated risk factors, and the pathogenetic role of infection, which may act both as a cause and a consequence of membrane rupture. Maternal and neonatal complications, including chorioamnionitis, neonatal sepsis, respiratory distress syndrome, and other severe conditions, are analyzed. Gestational age is shown to be the key determinant in selecting either active or expectant management and in defining the need for antibacterial therapy. Current recommendations from leading obstetrical societies regarding indications, timing, and antibiotic regimens for PROM are summarized, with particular attention to the role of macrolides and the clinical significance of maternal colonization with β-hemolytic streptococcus.

Conclusions. Rational management of pregnancy complicated by PROM should be based on gestational age, clinical context, and up-to-date evidence-based guidelines. Antibacterial therapy is justified in cases of expectant management before 37 weeks of gestation, in women with positive or unknown β-hemolytic streptococcus status, and in the presence of clinical signs of infection. An individualized approach combined with the principles of antimicrobial stewardship allows minimization of infectious complications and reduction of antimicrobial resistance risks.

The authors declare no conflict of interest.

Modern strategies of conservative treatment of stress urinary incontinence in women

K.I. Bohadelnikova — 2025-11-15

The prevalence of stress urinary incontinence among non-pregnant women aged 20 years and older ranges from 27% to 64%. Various methods of conservative therapy are used as first-line treatment for urinary incontinence, including lifestyle and dietary modifications, pelvic floor muscle training, pharmacological therapy, electrical stimulation, the use of vaginal cones or urethral obturators.

Aim - to summarize current evidence on the effectiveness and safety of conservative methods for the treatment of stress urinary incontinence in women in order to form clinical competencies, promote patient-centered approaches, and ensure coordinated care among healthcare professionals.

Contemporary domestic and foreign research were identified and analyzed using available literary sources and electronic databases. This review evaluates current data on the effectiveness of various conservative treatment methods for stress urinary incontinence in women. Behavioral therapy and pelvic floor muscle training are recommended as primary first-line treatments. If these prove insufficient, the use of vaginal support devices, such as pessaries, may be considered as the next step in management. Notably, no pharmacological therapy has been approved by the U.S. Food and Drug Administration (FDA) specifically for SUI in women. Further controlled studies evaluating the long-term outcomes of various non-surgical treatment modalities (urethral bulking injections, laser and radiofrequency therapy, stem cell injections, etc.) are required.

Conclusions. The range of conservative treatment options for stress urinary incontinence is quite broad. When selecting a potential treatment method, its potential benefits and possible side effects affecting other aspects of a woman’s life should be taken into account.

No conflict of interest was declared by the authors.

Sonographic assessment of endometrial receptivity in women during preparation for cryo-embryo transfer

O.O. Karlova — 2025-11-15

In modern reproductive medicine, against the backdrop of a global decline in fertility and the trend toward delayed motherhood, cryo-embryo transfer (CET) has become the "gold standard" of treatment. The transition from "fresh" cycles to cryo-protocols, which currently account for up to 77% of all assisted reproductive technologies (ART) cycles, is driven by the implementation of high-efficiency vitrification, the possibility of preimplantation genetic testing, and the near-total elimination of the risk of ovarian hyperstimulation syndrome. However, the success of the procedure critically depends on the synchronization between embryo readiness and endometrial receptivity.

Aim - to systematize ultrasound monitoring algorithms during preparation for CET within ART programs.

The article is devoted to the systematization of ultrasound monitoring algorithms as the primary tool for verifying the "implantation window." It analyzes patient preparation strategies within three main scenarios: natural cycle: focused on maximum physiological compatibility and utilizing the woman's own endocrine resources; hormone replacement therapy: the method of choice for patients with anovulation, providing clear control over endometrial proliferation and transfer timing; stimulated cycle: an alternative approach for cases of endometrial resistance. Special attention is paid to sonographic phenomena that predict successful implantation.

Conclusions. Ultrasound monitoring is an indispensable navigation method in CET cycles. Strict adherence to temporal deadlines (baseline assessment on days 2-3, proliferation control on days 9-10, and luteinization monitoring) allows not only for an increased pregnancy rate but also ensures a personalized approach to each patient, neutralizing risks associated with premature endometrial transformation or an "asynchronous window".

The authors declare no conflict of interest.

Correction of disorders of reparative processes after destructive methods of treatment of the cervix uteri

M.N. Shalko — 2025-11-15

Destructive methods of treatment of the cervix uteri (CU), unfortunately, lead to destructive-pathological changes in its integumentary epithelium and, as a result, to a violation of the reproductive function of a woman, which requires differentiated treatment tactics.

Аim - to evaluate the effect of local application of autoplasma enriched with platelets on the regenerative ability of the CU epithelium after destructive methods of treatment of its pathology in women of reproductive age.

Materials and methods. 170 patients aged 18-45 years with cervical intraepithelial neoplasia were selected. All patients were previously examined. Subsequently, individual and differentiated etiopathogenetic treatment was performed. 56 (32.94%) patients underwent cryodestruction of the cervical canal, 70 (41.17%) patients underwent excision of the cervical canal and 44 (25.88%) underwent cone-shaped diathermoelectroconization (DEC) of CU. The patients were divided into two groups. The control group was treated according to standardized methods, and the main group was treated with local application of autoplasma enriched with platelets.

Results. After cryodestruction, no pathological conditions of the cervical canal were detected in the main group; in the control group, 19 women had cicatricial deformation of the cervical canal. After excision, cicatricial deformation of the cervical canal was observed in 11 women in the main group; in the control group: 27 women were diagnosed with cervical canal stenosis of the cervical canal, 1 woman had cervical canal atresia of the cervical canal, and the rest had cicatricial deformation of the cervical canal. After performing cone-shaped diathermoelectroconization in the main group, cicatricial deformation of the cervix was observed in 13 women; in the control group: cicatricial deformation of the cervix was observed in 8, stenosis of the cervical canal of the cervix in 9, and atresia of the canal of the cervix in 5.

Conclusions. After local application of autoplasma, the frequency of destructive-pathological changes in women included in the study significantly decreased.

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 specified in the work. Informed consent of women was obtained for the study.

The authors declare the absence of a conflict of interest.

Current status of the problem of diagnostics in operative gynecology: emphasis on oncopathology

I.V. Lakhno — 2025-11-15

Providing surgical care to women with tumors of the genital organs requires reliable diagnostics, which is crucial for timely and adequate treatment of both benign and malignant diseases.

Aim - to perform a study of the frequency of malignant neoplasms of the female genital organs among patients operated from 2020 to 2025 for the optimization of perioperative diagnosis.

Materials and methods. A total of 4393 patients were included in the study, who underwent surgery from January 2020 to October 2025. All women involved in the work were divided into clinical groups according to the year of treatment. 619 patients were included in group I (treated surgically in 2020). There were 605 women in group II (2021). There were 718 women in group III (2022). There were 1522 patients in group IV (2023). Group V (2024) combined 1122 observations of operated women. Group VI (January-October 2025) included 1002 patients. All available data from the hospital automated system were analyzed, including passport, anamnesis, objective examination, instrumental and laboratory indicators, surgical interventions, and results of pathomorphological studies.

Results. The uterine adenocarcinoma was the most frequently diagnosed malignant pathology throughout the entire period of 2020-2025. The malignant neoplasms were “mimicked” as other benign pathologies. We recorded an extremely low sensitivity (25.5%) of cancer diagnostics. In 74.5% of cases, oncopathology was detected accidentally during histological examination of a biopsy. At the same time, high specificity (almost 100%) was noted. The preliminary suspicion of malignancy was almost always supported via histology.

Conclusions. Traditional preoperative methods are often unable to distinguish complex adenocarcinomas from ordinary polyps or hyperplasia. This confirms that pathohistological examination of material obtained during “minor” operations (hysteroscopy, curettage, polypectomy) is a critically important stage that corrects errors in the primary diagnosis.

No conflict of interests was declared by the authors.

Comparison of recurrence rates with different surgical approaches for pelvic organ prolapse

V.V. Kaminskyy — 2025-11-15

To date, there are insufficient data on the effectiveness of new laparoscopic approaches for the treatment of genital prolapse compared with vaginal surgery.

Aim - to determine the recurrence rate of genital prolapse after different surgical treatment options in women to compare the effectiveness of these treatment methods.

Materials and methods. The recurrence rate of genital prolapse was analyzed in 389 women, of whom 239 underwent vaginal surgery and 150 underwent laparoscopic surgical interventions. The types of interventions were as follows: for apical prolapse - vaginal hysterectomy (VH) without sacrospinous fixation and VH with sacrospinous fixation; for mixed prolapse - VH without sacrospinous fixation and VH with sacrospinous fixation; for apical prolapse - laparoscopic hysterectomy (LH) with promontofixation, with bilateral suspension, and with pectopexy; for mixed prolapse - laparoscopic LH with promontofixation and with pectopexy. Statistical analysis was performed using the SPSS 21 software.

Results. Laparoscopic surgical interventions for the correction of genital prolapse reduced the risk of recurrence from 34.7% to 18.7%, compared with vaginal surgery. Regardless of the type of genital prolapse, supplementation of vaginal hysterectomy with sacrospinous fixation was necessary, as it reduced the recurrence rate by 23.3% in apical prolapse and by 24.1% in mixed prolapse. The recurrence rate did not depend on the choice of the primary laparoscopic procedure in patients with apical prolapse; however, in cases of mixed prolapse, laparoscopic hysterectomy with promontofixation reduced the recurrence rate by 23.4%.

Conclusions. The obtained data indicate a higher effectiveness of various laparoscopic surgical approaches for the treatment of genital prolapse in women, as evidenced by a 1.9-time reduction in the risk of disease recurrence.

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 patients was obtained for conducting the studies.

The authors declare no conflict of interest.

Dynamics of HIV prevalence among pregnant women in Ukraine in 2016-2024: regional analysis

O.V. Feger — 2025-11-15

HIV infection remains an urgent medical and social problem and a significant challenge for the public health system. Monitoring the prevalence of HIV among pregnant women is of particular importance, as this indicator reflects the intensity of the epidemic process among women of reproductive age and the effectiveness of vertical transmission prevention programs. In Ukraine, the epidemiological situation is characterized by pronounced regional heterogeneity.

Aim - to analyze the dynamics and regional characteristics of the prevalence of HIV among pregnant women in Ukraine in 2016-2024.

Materials and methods. A retrospective descriptive epidemiological study was conducted based on the official statistical data of the Public Health Center of the Ministry of Health of Ukraine regarding the number of HIV-positive pregnant women registered in Ukraine and its regions in 2016-2024. The absolute indicators and their share in the national structure (%) were analyzed. A comparative analysis of the dynamics by years and regions was carried out with the determination of trends, structural changes and territorial differences. Methods of descriptive statistics were used.

Results. During the studied period, a steady trend towards a decrease in the number of HIV-positive pregnant women was established: from 2,814 cases in 2016 to 1,083 in 2024, which is a decrease of 61.5%. The most pronounced reduction was noted after 2021. During the entire period, the highest absolute indicators were registered in the Dnipropetrovsk and Odesa regions. In 2024, their share was 15.6% and 17.0% of the total number of cases in Ukraine, respectively. A significant decrease in indicators was observed in the Donetsk, Zaporizhzhia and Kherson regions after 2021. The western regions were characterized by relatively low and stable indicators. Despite the overall decrease in the number of cases, regional disparities persist.

Conclusions. In 2016-2024, a consistent decrease in the prevalence of HIV among pregnant women was noted in Ukraine. At the same time, significant regional unevenness remains, with the concentration of most cases in the southern and eastern regions. The sharp decrease in rates after 2021 needs to be interpreted with caution, taking into account possible changes in the availability of medical care and the completeness of case registration. Further epidemiological monitoring and strengthening of programs for the prevention of vertical transmission of HIV are necessary.

The authors declare no conflict of interest.

Prolonged epidural analgesia as a component of treatment for uterine inertia

A.O. Zhezher — 2025-11-15

The effectiveness of treating labor weakness largely depends on anesthetic care, as modern obstetric care requires mandatory pain relief during labor, regardless of its nature. The search for an optimal method of labor pain relief remains relevant due to the risk of developing or exacerbating uterine inertia when using traditional epidural analgesia techniques.

Aim - to improve the effectiveness of anesthetic management in women with existing uterine inertia to ensure successful vaginal delivery.

Materials and methods. An analysis of 60 labor cases was conducted. The parturients were divided into two groups: Group I (study group, n=35) — delayed administration of local anesthetic (analgesia initiated with 50 mcg of fentanyl, while bupivacaine (0.125-0.25%) was administered only on demand after 1-1.5 hours); Group II (control group, n=25) — standard technique (simultaneous administration of bupivacaine (0.125-0.25%) and 50 mcg of fentanyl for analgesia initiation). The effectiveness of analgesia was assessed using the visual analog scale, maternal hemodynamic parameters, and the mode of delivery. Fetal status was monitored via cardiotocography.

Results. In the study group, the rate of physiological deliveries was 69%. The use of a pure opioid at the initial stage allowed for the relief of "sympathetic stress" and normalization of the autonomic nervous system function, which facilitated the effective action of oxytocin. In the control group, only 18% of women had a vaginal delivery, while 72% required an emergency cesarean section due to ineffective labor activity and fetal distress.

Conclusions. Starting neuraxial analgesia with opioids without a local anesthetic is pathogenetically justified in cases of uterine inertia. It allows for breaking the "pain-stress-oxytocin inhibition" cycle without creating a premature motor block, significantly reducing the rate of operative delivery.

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 institution mentioned in the paper. Informed consent was obtained from all participating women.

The authors declare no conflict of interest.

Differences in the levels of some serum biomarkers in pregnant women with pathological placentation (PAS and placenta previa) compared with the physiological course of pregnancy

N.V. Gerevich — 2025-11-15

Placenta previa (PP) and placental invasion anomalies (placenta acreta spectrum - PAS) are an urgent problem of modern obstetrics. The study of biomarker levels of the above nosologies is currently considered to have good prospects in terms of improving the method of diagnosing PP and PAS.

Aim - to investigate the levels of Osteopontin (OPN), Soluble fms-like tyrosine kinase-1 (sFLT-1) and Placental growth factor (PlGF) in serum in pregnant women with PAS, with placenta previa and with a physiological course of pregnancy.

Materials and methods. A prospective case-control study conducted for the period 2024-2025. The study included 143 pregnant women with a gestational age of 25-26 weeks, who were divided into groups: the first - 43 pregnant women with placenta accreta spectrum (PAS) type placental invasion disorder, the second - 49 pregnant women with placenta previa without PAS, the control group consisted of 51 pregnant women with a physiological course of pregnancy. The levels of OPN, sFlt-1 and PlGF in blood plasma were tested and the sFlt-1/PlGF ratio was calculated.

The results of the study of OPN, sFlt-1 and PlGF levels in serum showed: the distribution of continuous variables was asymmetric, differences were found between the groups in sFlt-1, PlGF and sFlt-1/PlGF and no differences in OPN. PlGF levels in the serum of pregnant women of the second and control groups did not differ. The sFlt-1/PlGF ratio was significantly reduced in the first group compared to the second and control groups. Comparative ROC analysis showed that the highest specificity and sensitivity for the diagnosis of PAS had the sFlt-1/PlGF ratio, sFlt-1, PlGF and OPN levels had no prognostic significance.

Conclusions. The level of OPN in serum in the second trimester in PAS and PP disorders does not differ from that in normal pregnancy. The level of PlGF is increased in PAS, but the results are contradictory. The level of sFlt-1 in PAS is significantly reduced. The ratio of sFlt-1/PlGF in PAS is significantly lower than normal and has the highest sensitivity and specificity in their prediction.

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 the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

The combination of cognitive-behavioral therapy and pharmacological correction of sleep disorders as the most effective approach to preventing perinatal complications in pregnant women

S.V. Frolov — 2025-11-15

Aim - to assess the effectiveness of different approaches to the correction of sleep disorders in pregnant women from the perspective of their impact on sleep quality and the incidence of perinatal complications.

Materials and methods. A randomized clinical trial was conducted with the participation of 245 pregnant women from October 2022 to December 2024. Group I - 175 pregnant women with sleep disorders, and group II - 70 pregnant women without sleep disorders were formed by simple randomization. Group I was divided into three subgroups by blind randomization: Ia (n=49) - cognitive behavioral therapy (CBT) for 10 weeks using the Sleepio for Pregnancy electronic application; Іb (n=55) - complex therapy (psychoeducation on sleep hygiene, vitamin-mineral complex, micronized progesterone); Іc (n=71) - a combination of CBT and complex therapy. Verification of sleep disorders was carried out using an adapted version of the Pittsburgh Sleep Quality Index for Pregnancy (PSQI-P), the Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). The examinations were carried out in the II-III trimesters (22-41 weeks). The primary and secondary endpoints included the frequency of threatened preterm birth, hypertensive disorders, gestational diabetes, cesarean section, low birth weight and postpartum hemorrhage. Statistical analysis was performed using the Student's t-test.

Results. Before treatment, no significant differences were found between subgroups Іa and Іc in the frequency of perinatal complications, while they were significantly different from group II. After therapy, a significant decrease in the frequency of threatened preterm birth, hypertensive disorders, cesarean section and low fetal weight was recorded in subgroup Ic, as well as a significant improvement in PSQI-P, ISI and ESS indicators. The difference between subgroup Ic and the group II became statistically insignificant.

Conclusions. Combining CBT and complex pharmacotherapy is the most effective approach to correcting sleep disorders in pregnant women, reducing the frequency of perinatal complications to the level of healthy pregnant women.

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 indicated in the work. Informed consent of the women was obtained for the study.

The authors declare no conflict of interest.

Features of the course and outcomes of pregnancy in primiparous women with early preeclampsia

А.V. Chernov — 2025-11-15

Aim - to study the features of the course and outcomes of pregnancy in primiparous women with early preeclampsia to predict and optimize obstetric tactics in them.

Materials and methods. An analysis of pregnancy outcomes was conducted in 78 primiparous women. Participants were divided into two groups: Group I - 38 pregnant women with early preeclampsia, Group II - 40 pregnant women without early preeclampsia. The study evaluated the incidence of pregnancy complications, levels of human beta-chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A), as well as Doppler parameters of the uterine arteries at 18-21 weeks of gestation. Statistical processing was performed using standard software.

Results. The course of pregnancy in primiparous women with early preeclampsia was characterized by a significant 1.6-fold increase in the incidence of gestational anemia: 14 (36.8%) cases in Group I versus 9 (22.5%) in Group II. Early placental insufficiency (PI) with fetal growth retardation syndrome (GRS) was also significantly more frequent in Group I - 18 (47.4%) cases compared to 3 (7.5%) in Group II. Pregnancy outcomes in these women included the birth of children with significantly lower body weight (2288.8±620.4 g) and body length (49.2±4.4 cm); an Apgar score of <7 points was recorded in 23.6% of cases.

Conclusions. Key features of pregnancy in primiparous women with early preeclampsia include PAPP-A levels below 2 ng/ml, hemodynamic disturbances in the fetoplacental complex at 18-21 weeks, and a high prevalence of gestational anemia (36.8%), early placental insufficiency with fetal growth retardation (47.4%), and oligohydramnios (15.8%).

The research was carried out 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 paper. Informed consent was obtained from all participants prior to the study.

The author declares no conflict of interest.

Dichoirial triamniotic triplets after in vitro fertilization, complicated by twins to twins transfusion syndrome and the death of two fetuses at 19 weeks of gestation: a clinical case of successful pregnancy and full-term delivery

V.О. Sklyarovа — 2025-11-15

Triplet pregnancy after assisted reproductive technologies (ART) carries risks of complications for both the woman and the fetuses. Multiple pregnancies are becoming more common due to the widespread use of ART, particularly in vitro fertilization. Although single blastocyst transfer has become the standard, cases of monozygotic twin pregnancies and complicated multiple pregnancies remain relevant.

Aim - to present a rare clinical case of dichorionic triamniotic triplets after the use of ART, complicated by twin-to-twin transfusion syndrome (TTTS) and intrauterine death of two fetuses, as well as to analyze management tactics and perinatal outcome.

Clinical case. A 29-year-old patient underwent in vitro fertilization. After the transfer of two blastocysts, dichorial triamniotic triplets were diagnosed. At 19 weeks of pregnancy, TTTS developed in a pair of monochorionic fetuses. They died in utero, but one fetus continued to develop in its amniotic sac. The pregnancy was successfully carried to 37 weeks, delivery was by cesarean section, and the newborn was healthy. This case highlights the clinical complexity of managing dichorionic triamniotic triplets with TTTS complications and the death of two fetuses at 19 weeks. The main dilemma was whether to continue the pregnancy after the intrauterine death of two fetuses. Given the stable condition of the mother and positive dynamics of ultrasound, D-dimer, and blood counts, the pregnancy was continued. The perinatal outcome indicates the use of a personalized approach.

Conclusions. Despite the risks, the strategy of maintaining pregnancy with intrauterine monitoring showed positive results. This case may be useful for obstetricians and gynecologists who encounter similar cases.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent was obtained from all participants.

The authors declare no conflict of interest.

A series of clinical observations of venous thrombosis in women taking combined oral contraceptives

I.O. Rodionova — 2025-11-15

Aim - to analyze the issue of comprehensive assessment of the risk of venous thromboembolism (VTE) when prescribing combined hormonal contraceptives (CHCs), to determine the significance of genetic, clinical and laboratory risk factors, including thrombophilias and other indicators of hemostasis, and to justify approaches to individual decision-making regarding the safe use of CHCs.

The article analyzes the issues of comprehensive assessment of the risk of VTE when prescribing CHCs. It is justified that the patient's clinical characteristics - efficacy and tolerability - are not sufficient; the risk of VTE should be taken into account, in particular, taking into account genetic factors such as factor V Leiden mutation, anticoagulant deficiencies: antithrombin, protein C and S; other laboratory indicators of hemostasis. It has been shown that the presence of a heterozygous Leiden mutation increases the risk of VTE by 30 times, and homozygous - up to 100 times when taking combined hormonal contraception. In cases with existing “severe” thrombophilia (antithrombin, protein C and S deficiency), try to avoid the use of combined oral contraceptives with ethinylestradiol. At the same time, the absence of hereditary thrombophilia does not eliminate the risk of thrombosis, namely situational factors, such as increased levels of clotting factors, a shortened activated partial thromboplastin time due to being overweight, smoking, varicose veins of the lower extremities, or prolonged immobilization increases the likelihood of VTE. The author emphasizes that the decision to use hormonal contraception should be based on a comprehensive individual assessment of thrombotic risk, taking into account genetic, clinical and laboratory factors and suggests evaluating the activated partial thromboplastin time as a simple, accessible, and fairly informative screening test before prescribing contraceptives.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent was obtained from all participants.

The author declares no conflict of interest.