Today, cesarean scar pregnancy is a rare type of ectopic pregnancy (1:18001: 2200). Moreover, the mortality rate in cesarean scar pregnancy is 191.2 per 100 000 cases, that 12 times exceeds the mortality rate in tubal pregnancy. In this article, we present a clinical observation of a rare case of cesarean scar pregnancy, as diagnosed by ultrasonography, in a 23-year-old patient after the cesarean surgery. The diagnosis was based on clinical, biochemical and ultrasound studies. Ultrasound played a crucial role in the determination of the fetus localization. Pathological pregnancy was eliminated by means of excision of the old scar and restoration of the uterine wall integrity. Such cases are becoming more common in connection with the increase in the frequency of caesarean sections, the improvement of technology, continuing medical education and professional development in the field of ultrasound. Knowledge of differential diagnosis can save the patient's life since the outcomes of cesarean scar pregnancy include severe complications with a possible loss of patients fertile function and immediate risk of death.

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Aim: to develop individualized options for correcting sex steroid deficiency in early postmenopausal patients with uterine leiomyoma.Materials and Methods. 180 postmenopausal patients with uterine leiomyoma were examined. To correct menopausal manifestations, patients were prescribed: Group 1 (n = 60) – low-dose drug estradiol 1 mg/drospirenone 2 mg, Group 2 (n = 60) – ultra-low-dose drug estradiol 0.5 mg/drospirenone 0.25 mg, Group 3 (n = 60) – patients refused to take menopausal hormone therapy (MHT). Clinical and anamnestic, laboratory and instrumental examination was carried out by assessing vasomotor and genitourinary symptoms. Special attention was paid to ultrasound examination of the pelvic organs with Dopplerometry of the intratumoral vessels.Results. The vasomotor manifestations of menopausal syndrome in postmenopausal patients with uterine leiomyoma were effectively relieved with drug containing 17β-estradiol/drospirenone, regardless of component dosage (RR = 0.25). The size of nodes in uterine leiomyoma type 2–6 according to classification of The International Federation of Obstetricians and Gynecologists (FIGO) as well as Dopplerometry data in the uterine artery in postmenopausal women showed no changes after 9-month use of 17β-estradiol/drospirenone. In Group 1, increased vascularization intensity (RR = 1.4) and decreased peripheral vascular resistance in intranodular vessels were revealed in 6 % patients.Conclusion. The use of MHT drugs at varying component doses did not enlarge size of leiomyoma nodes nor affected hemodynamic parameters in the uterine arteries during 6-month-treatment. However, while prolonging MHT duration, it increased vascularization of myoma nodes assessed by measuring intranodular blood flow, increased vascularization and decreased resistance index after administering low-dose vs. ultra-low-dose MHT therapy that should be taken into account upon planning therapeutic regimen and its timeframe.

Menopause is a physiological period during which involutional processes in the reproductive system predominate in a woman's body. Vitamin D deficiency increases the risk of age-related diseases, so it is important to examine and, if necessary, adjust the level of vitamin D. Purpose of the study. To determine the relationship between vitamin D levels and the severity of menopausal syndrome in postmenopausal women. Materials and methods. A cross-sectional study was conducted, which included data on 150 patients who applied for a gynecological appointment with complaints of manifestations of menopausal syndrome (CS). Results. As a result of the study, it was revealed that out of 150 women with manifestations of menopausal syndrome, the average level of 25(OH)D in the blood serum was 25.3(7.5) ng/ml. At the same time, in 49 (33%) of the surveyed, the content of hydroxyvitamin D was normal, a deficiency was observed in 53 (35%), and in 48 (32%), the indicators corresponded to a deficiency. However, the correlation analysis of the relationship between the level of vitamin D and the severity of the climacteric syndrome did not reveal a statistically significant relationship between the studied parameters (p=0.317). Conclusions. The severity of menopausal syndrome does not depend on the level of vitamin D in the blood, which confirms the leading role of hypoestrogenism in the etiopathogenesis of this condition.