Problems in the realization of childbearing are relevant in the medical, socio-economic and personal-psychological aspects. The endometrial factor occupies a significant place in the polyethiologic syndrome of reproductive losses. The full receptivity of the endometrium at the time of interaction with the blastocyst causes a successful completion of implantation and further progression of pregnancy. The review presents an analysis of current data on the morphological and proteomic (ultrastructural) levels of the receptivity of the endometrium and their role in the genesis of reproductive dysfunctions.

Hypothesis/aims of study. The frequency of surgical abdominal delivery in Russia, as in the world, continues to grow, reaching 29.3% in 2017. Operative vaginal delivery is an alternative to abdominal delivery in the second stage of labor. This study was aimed at analyzing the outcome of labor for mothers and newborns using different operative vaginal delivery methods. Study design, materials and methods. We studied 293 cases of childbirth in the period from 2015 to 2018. Three groups were distinguished: (I) the main group consisting of 172 women delivered by the operation of applying obstetric forceps (OF); (II) the comparison group including 85 patients delivered by the operation of vacuum extraction (VE) with the fetal head being near the pelvic floor; and (III) the control group comprising 34 cases of vaginal birth without use of instrumental delivery. In group I, 114 patients were delivered by the low forceps operation (subgroup IA), and 60 individuals by the mid forceps operation (subgroup IB). Results. Vaginal lacerations were found in 21.3% of cases in group I, less often less often in groups II (10.6%, p 0.05) and III (2.9%, p 0.05). Vaginal hematoma occurred in one patient of group III (2.9%) and three women of group I (1.7%, p 0.05). There were no cases of damage to the anal sphincter. The greatest blood loss was recorded in subgroup IB (554 44.9 ml), when compared to subgroup IA (473 20.7 ml; p 0.05), group II (418 24.9 ml; p 0.05), and group III (347 33.4 ml; p 0.05). There were no differences in blood loss between the outlet OF and VE groups (p 0.05). Most newborns were born in good condition (84.5%, 77.6%, and 88.2% of cases in groups I, II, and III, respectively). Cephalohematoma in newborns was more common after VE (32.9%) than after OF (9.2%, p 0.01) and in control (5.9%, p 0.01). No retinal hemorrhage was recorded in newborns. There were no significant differences in the frequency of children being transferred to the childrens hospital (7.5%, 9.4%, and 8.8% of cases in groups I, II, and III, respectively; p 0.05). Conclusion. The use of OF is an effective and safe method of vaginal operative delivery. It does not increase the fetal injury rate, the frequency of newborn cephalohematoma being 3.5 times less than with VE. Complications of OF and VE (except for a greater number of vaginal lacerations in cases of OF), blood loss, and the course and duration of the postpartum stay in the maternity ward are comparable.

Aim: to evaluate the endometrial expression of e-cadherin in relation to the estrogen-progesterone-receptor status of the endometrium.Materials and methods. In total 137 women were examined including 81 patients with infertility and 40 with a history of early pregnancy loss (main group); for comparison, 16 healthy fertile women (control group) were also examined. Endometrial aspiration biopsy was performed on 6–8 days after ovulation; in parallel, a peripheral blood sample was taken to determine the levels of estradiol and progesterone. A histological and immunohistochemical study of the endometrium with determination of estrogen (ER) and progesterone (PR) receptors and e-cadherin expression was carried out.Results. All fertile women (n = 16) and only 44 % (n = 53) of patients in the main group had the normal pattern of hormonereceptor endometrial interactions, i. e., low expression of ER and PR in the endometrial glands as well as reduced expression of ER and high expression of PR in the endometrial stroma. The endometrial e-cadherin expression was assessed in the following cohorts: a) women with normal hormone-receptor interactions (16 women in the control group and 53 women in the main group); b) with abnormal variants of hormone-receptor interactions in the endometrium (68 patients in the main group). The frequency of reduced e-cadherin expression was significantly lower in the cohort of women with normal estrogenprogesterone-receptor endometrial status (a) than in the cohort of women with abnormal variants of the endometrial “response” (b): in the luminal epithelium – in 5 % (3 out of 63) (а) vs. 17 % (8 out of 47) (b) (p < 0.05); in the glands – in 13 % (9 out of 69) (a) vs. 37 % (25 out of 68) (b) (p < 0.05).Conclusion. The estrogen-progesterone-receptor status of the endometrium is significant for the e-cadherin expression in the luminal epithelium and glands of the endometrium.

Background ― The endometrial factor is important in miscarriage (MC) pathogenesis. Objective. To perform a morphofunctional evaluation of endometrium in the patients with uncertain MC cause in anamnesis. Material and methods ― We examined 48 women 23-40 yo [30 (27, 35)]: the main group consisted of 33 patients with early MC in their medical history, while the control group included 15 healthy fertile women. All women had an ovulatory menstrual cycle, normal levels of gonadotropic and thyroid hormones, prolactin, and androgens. Ultrasound and hormonal examinations, along with morphological investigation of endometrial biopsies were performed. Data presented as median with lower and upper quartiles – Me (LQ, UQ). Results ― In 64% (n=21) of women in the main group, we detected inferior secretory phase of their endometrial cycle, focal fibrosis of endometrial stroma; synchronous overexpression of estrogen (ER) and progesterone (PR) receptors in endometrial glands and stroma. ER in the glands was 240 (160, 280) vs. 130 (80, 210) in the stroma, while PR values were 270 (210, 290) in the glands vs. 270 (240, 280) in the stroma: differences from the control group were significant (p<0.01). Remaining women in the main group (36%, n=12) and all women in the control group had full secretory transformation of the endometrium and normal expression of ER and PR. The levels of estradiol and PR in the blood of women with early MC in anamnesis, with different variants of ER and PR expression in the endometrium, did not differ significantly from the control group and corresponded to the reference values. Conclusion ― Nearly two-thirds of women with early miscarriage in anamnesis exhibited overexpression of ER and PR in the endometrium, which may be one of the indicators of its decreased receptivity status.

BACKGROUND:Uterine fibroids are increasingly diagnosed in patients of reproductive age. Combined hormonal contraceptives provide reliable protection against unwanted pregnancy and help to reduce or eliminate various clinical manifestations of uterine fibroids. In practice, obstetrician-gynecologists have barriers to prescribing combined hormonal contraceptives to patients with uterine fibroids. AIM:The aim of this work was to study the features of the clinical approach of obstetrician-gynecologists to the management of patients with uterine fibroids interested in combined hormonal contraception. MATERIALS AND METHODS:The method of voluntary anonymous questioning was applied to 366 obstetrician-gynecologists. The work experience of 62.1% (n= 227) of doctors was 10 years or more. The questionnaire included questions about various aspects of the use of combined hormonal contraceptives for contraception in women with uterine fibroids. RESULTS:Only every second (47.5%;n= 174) obstetrician-gynecologist correctly assigns uterine fibroids to the first category of acceptability for combined hormonal contraceptives. The presence of an asymptomatic submucous myomatous node (FIGO 12) or dysmenorrhea in women with uterine fibroids is considered by 29.0% (n= 106) and 5.7% (n= 21) of obstetrician-gynecologists, respectively, as a contraindication to the use of combined hormonal contraceptives. Every ninth participant (11.4%;n= 42) believes that the presence of uterine fibroids limits the duration of use of combined hormonal contraceptives for contraception to 15 years. Almost half (45.6%;n= 167) of the respondents believe that combined hormonal contraceptives have various effects on uterine fibroids (cause regression or growth of fibroids, increase the risk of new fibroids). More than half (53.3%;n= 195) of the respondents are not informed about the reduction in the risk of developing uterine fibroids when using combined hormonal contraceptives for five years or more. CONCLUSIONS:In the analyzed cohort of experienced obstetrician-gynecologists, we identified their barriers to prescribing combined hormonal contraceptives for contraception for women with uterine fibroids. Those are incomplete awareness of the acceptance criteria for combined hormonal contraceptives and insufficient awareness of the lack of effect of combined hormonal contraceptives on the size of existing myomatous nodes and a decrease in the risk of developing uterine fibroids when using combined hormonal contraceptives for five or more years.