The problem of nutrition during pregnancy is relevant all over the world because of globalization. Globalization has brought fast food, sweets and improper nutrition. As a result of such nutrition, hunger is quenched, and saturation of the body with the necessary nutrients does not occur. As a result, the number of meals and their volumes increase, which leads to a vicious circle. Mom gains weight, and the fetus suffers even more: receiving a signal about insufficient intake of nutrients, it activates the genes for storing these nutrients and becomes obese after birth. Therefore, starting from the early stages of pregnancy, it is necessary to evaluate the eating behavior of a pregnant woman and make recommendations for its correction. The necessity and importance of nutritional support for gestation, adequate preparation for pregnancy is undeniable.

It has been increasingly recognized that structural abnormalities and functional changes in the placenta can adversely affect developing fetal heart. In this article, we examine a role of the placenta as well as potential impact of placental insufficiency on a fetus with congenital heart disease (CHD). The fetal heart and placenta are directly connected because they develop simultaneously with common regulatory and signaling pathways. Moreover, placenta-associated complications are more common in pregnant women carrying fetus with CHD, and the fetal response to placental insufficiency may lead to postnatal preservation of remodeled heart. The mechanisms underlying this placenta–fetus axis potentially consists of genetic factors, oxidative stress, chronic hypoxia, and/or angiogenic imbalance. Thus, the mother–placenta–fetus circulation is critical in understanding the CHD formation. It is necessary to study the changing factors involved in these processes for early identification, imaging, quantification of placental insufficiency, and development of new prenatal therapies in the CHD patient population.

Altered pelvic venous circulation, which may occur due to pelvic venous congestion and varicose veins of the vulva, may be among the causes for developing chronic pelvic pain syndrome. Pelvic congestion syndrome (PCS) is characterized by chronic discomfort in the pelvic area, which may be aggravated during coitus or acquire orthostatic position, and result in severe dysfunction of the pelvic organs. Varicose veins of the vulva develop due to obstruction of the veins, increased venous pressure, and venous insufficiency in the pelvis. Varicose veins may be isolated or associated with varicose veins of the lower extremities. The diagnosis and treatment of such patients are limited by the lack of definitive clinical criteria for early diagnostics, which were discussed in the current study.

Objective To increase the effectiveness of intervention for the lower limb arteries multilevel lesion (MPAD) in patients with type C and D lesions by TASC II classification. Materials and methods 87 hybrid vascular reconstructions (74 male and 13 female, 59% (n=52) smokers) for MPAD were performed from 2017 to 2020. The average age was 64,6±8,1y. CLI was diagnosed in 47% (n=41) by Fontaine- Pokrovsky classification. Following concomitant disease were diagnosed: stage 2–3 of CHF by HYHA classification 33% (n=29), COPD 23% (n=20), arterial hypertension stage 2–3 54% (n=47), CAD 66% (n=58), postinfarction cardiosclerosis 29% (n=26). Registered lesion of iliac-femoral segment type A/B=44 (51%) and C/D=43 (49%); registered lesion of femoro-tibial segment A/B=14 (16%), C/D=73 (84%) by TASC-II classification. Common femoral artery (CFA) bifurcation was most important to perform hybrid intervention. Through CFA with patented method (RU 2621395C) we performed remote endartherectomy from external iliac or superficial femoral arteries, that allowed us to remove a total prolonged occlusion (>15–20 cm), reducing the time and complexity of the endovascular stage. The key note is that we perform CFA plasty with using an autovenous patch with a “trunk” through which we provide endovascular stage of hybrid intervention on natural blood flow, restored after open endartherectomy. This technique allows you to change the direction of introducer in both distal and proximal direction without the need for extra punctures or temporary clamping of the arteries. Results Technical success rate was 98%. Local aneurysm of EIA was found in one case that restricted to provide the loop endarterectomy. The average duration of hybrid operation was 223,7±88,2 min (134,2±72,3 min for open and 89,9±52,9 for endovascular stages). Average blood loss was 225,3±130,7 ml. ICU staying duration was 20,6±2,8 hours. 30-days patency was 98,8%, 12 and 36 months primary patency was 98% and 88,5% respectively. There were no deaths within 30 days after hybrid operation. The following complications occurred: bleeding n=2 (2,3%), acute thrombosis n=1 (1,2%), surgical site infection n=1 (1,2%) but cured safely. Limb salvage in critical ischemia was in 100% of patients for 20 months. Conclusion Hybrid surgery of MPAD is highly effective, reduces operation trauma, improves its results and limb salvage. By reducing trauma of surgical intervention reduces admition in ICU, postoperative risks, especially in patients with severe concomitant pathology. FUNDunding Acknowledgement Type of funding sources: None.