The aim: To reduce the frequency and severity of preeclampsia, to improve obstetrical and perinatal outcomes in women with multiple pregnancy after assisted reproduction by the development and implementation of the preventive algorithm with biochemical markers of endothelial dysfunction prospective analysis. Materials and methods: Clinical and laboratory prospective analysis of 54 cases of twins in women, treated from infertility with assisted reproductive technologies (ART), using the method of intracytoplasmic sperm injection (ICSI) and frozen embryos transfer, have been made. It was proven, that women with multiple pregnancy are always in a high risk group of placental dysfunction (PD) and preeclampsia (PE). Depending on the treatment algorithm and preventive measures, 2 groups of patients were formed. Group I included 29 pregnant women with twins, managed in accordance with developed recommendations. We didn’t find evidence-based European guidelines, that would recommend routine prescription of progesterone to improve chorion invasion and further placentation in such group of patients, but in order to prevent endothelial dysfunction and to decrease the incidence and severity of preeclampsia, placental abnormalities and intrauterine growth restriction (IUGR), we proposed the following algorithm: – micronized progesterone 200 mg vaginally (PV), as soon as pregnancy was diagnosed by positive hCG-test, till 16 weeks of pregnancy, angioprotector diosmin 600 mg once daily orally (PO), 2 courses: from 8 till 12 and from 16 till 20 weeks of gestation, antiaggregant – acetylsalicylic acid 150 mg from 12 till 36 weeks of gestation. Group II included 25 pregnant women with twins after the same ART procedures, who have not received above mentioned treatment. Plasma concentrations of PlGF, sFlt-1 and the ratio of sFlt-1/PlGF in the second trimester were investigated in both groups of women in order to assess the effectiveness of proposed preventive measures. Results: Usage of preventive algorithm has shown the reduction of PE incidences in 26%, PD in 28.1%, IUGR in 35%, prematurity by 23% and fetal distress in 18%, that led to improvement of obstetrical and perinatal outcomes in I group of women with multiple pregnancies after ART-treated infertility, compared with group II (p<0.05). The evaluation of PlGF, sFlt-1 plasma concentrations and the ratio of sFlt-1/PlGF in the second trimester of pregnancy reflected the effectiveness of our method in women with twins after ART. The level of PlGF in the study group was higher (186.5 ± 12 vs 154.2 ± 10.7; p<0.05), and the level of sFlt-1 was lower (1523.1 ± 40.3 vs 1835.3 ± 33.6; p <0.05). Results of sFlt-1/PlGF ratio analysis in the I group also showed effectiveness of the method proposed (20.3 ± 3.1 vs 28.1 ± 2.2; p<0.05). Conclusions: The observed results suggest, that pregnant women with twins after ART-treated infertility are in a high-risk group of PE, PD and IUGR of one or both fetuses. Implementation of the proposed preventive algorithm allows to reduce the incidence of PE, obstetrical and perinatal complications in this group of patients, and can be widely used in clinical practice. Evaluation and prospective assessment of biochemical markers, such as PlGF, sFlt-1 and sFlt-1/PIGF ratio, in the second trimester of pregnancy in the target groups may likely predict the development of PE and its severity.

This article is devoted to the actual problem of reproductive health of married couple with urogenital infections in anamnesis.The review of modern research summarizes the theoretical and statistical data of recent years. It was considered the contemporary ideas about the etiopathogenesis of male and female infertility, namely the effects of transmitted urogenital infections on the occurrence of disorders in the female and male genitourinary systems. The attention is paid to the analysis of the complications of further planned pregnancy in the couple with the urogenital infections in anamnesis. Key words: reproductive health, urogenital infections, infertility, pregnancy, mixed infection, married couple, sexually transmitted diseases (STDs).

The objective: to analyze the morphological and immunohistochemical features of the endometrium in the patients with chronic endometritis after unsuccessful attempts of assisted reproductive technologies (ART). Materials and methods. A prospective study was conducted in women with a history of chronic endometritis on the basis of the Medical Center LLC “ISIDA-IVF” for the period from 2019 to 2021. The I group included 55 women of reproductive age with chronic endometritis and repeated unsuccessful attempts of ART, the control group (CG) – 40 women of reproductive age without fertility disorders who are preparing for the replacement motherhood programs or who are oocyte donors. The results of the endometrial biopsy performed on the 5–7th and 19th–21st days of the menstrual cycle using a pipelle aspiration curette were studied for the assessment of the immunomorphological characteristics of the endometrium in the patients with chronic endometritis. The immunoperoxidase method with primary specific monoclonal antibodies was used for the immunomorphological study of estrogen and progesterone receptors. Differences at p<0.05 were considered statistically significant. Results. Pathomorphological study of the endometrium revealed characteristic signs of chronic inflammation – the presence of a large number of plasma cells in the endometrium stroma, lymphoid infiltrates near the blood vessels and the gland orifices, unevenly expressed stroma fibrosis, sclerotic changes in the walls of spiral arteries. All examined persons had two or more morphological signs of chronic endometritis (CE). An increase number of macrophages and monocytes in the endometrium glands and stroma was found by CE – 31.3±2.9 % versus 2.3±0.1 % in CG (р<0.05). An increase proliferative activity of epithelium cells of the endometrium glands and stroma on the 5-7th day of the menstrual cycle in patients in the I group compared to similar indicators of the secretion phase in CG was determined. The proliferation of glandular and stromal cells, detected on the 19th–21st days of the menstrual cycle, had the intensification of the programmed cell death process in the covering and glandular epithelium of the endometrium. This was characterized by the structural changes in the cell nuclei – the marginal state of chromatin, the appearance of karyorrhexis and karyopyknosis. In the endometrium stroma the presence of capillary-type vessels was found, the intensity of their development had a strong correlation with the degree of severity of the inflammatory changes (r=0.74; p<0.05). During the study of progesterone receptors mainly a decrease of the level of expression in the glands both compared to the indicators of healthy women and in the secretion phase compared to the proliferation phase - H-score 145.5±7.7 was found, in the proliferation phase versus H-score 55.5±10.4 in the secretion phase (р<0.05). Conclusions. Immunomorphological study of the endometrium in patients with chronic endometritis after unsuccessful attempts of assisted reproductive technologies demonstrates that the inflammatory changes in the tissues have clear morphological criteria, which are most pronounced on the 5-7th day of the menstrual cycle – the presence of plasma cells, stroma fibrosis, sclerosis vessel walls, decrease of the estrogen and progesterone level receptors. These morphological and immunohistochemical changes persist in the secretory phase of the menstrual cycle with the most significant manifestations in the form of a decrease in the level of progesterone receptors.

The article presents a review of the literature in recent years on the problem of peritoneal pelvic adhesions in women of reproductive age. The main issues of etiology and pathogenesis of peritoneal pelvic adhesions as one of the leading causes of reproductive dysfunction, chronic pelvic pain and surgical complications in patients of reproductive age are highlighted. It has been shown that the main etiological preconditions for formation of adhesions and the development of adhesive intestinal obstruction are a peritoneal injury, intraabdominal bleeding, presence of infection, influence of various aggressive substances, local antibiotic therapy, and regional tissue ischemia. Peritoneal commissures have high health and social significance due to a wide range of surgical procedures causing peritoneal trauma and to a high frequency of adhesive process. Pelvic adhesion is a dynamic differentiated cell vascularized structure. Development of an active inflammatory process, which involving cells and proinflammatory mediators may be into a stage of tissue remodeling, collagen formation, that is the initial symptoms of adhesions. A vicious circle and a cascade of mutually supporting changes leads to adhesive disease and patients’ disability. Whatever reasons of adhesions are, ones are a major cause of pelvic pain, infertility and ovarian failure. Though the researches of the pathophysiological mechanisms of growth of adhesions are going on the attempts to determine effective methods to prevent adhesions do not rule to expected results. Keywords: peritoneal adhesions, adhesive disease, etiology, pathogenesis, prevention, treatment, reproductive age.

The objective: to study the effectiveness of hemostatic therapy with tranexamic acid in pregnant women with miscarriage that started. Materials and methods: The study group included 110 pregnant women with a miscarriage that began with the onset of retrochoric hematoma, from 5 to 22 weeks of gestation. The main group was 60 pregnant women who received hemostatic therapy with the drug tranexamic acid Vidanol in a daily dose of 1000–1500 mg until stopping the bleeding. The comparison group consisted of 50 pregnant women who received standard hemostatic therapy with etamsylatum. On ultrasound, retrochorionic / retroplacental hematomas were noted in 27 women of the main group (45%) and 22 patients in the comparison group (44%), extramembrane hematomas were diagnosed in 8 (13.3%) and 9 (18%) women, respectively. Placenta presentation was observed in 7 (11.7%) and 8 (16%) women of both groups, respectively. In the rest of pregnant women there was a bloody discharge from the genital tract as a result of detachment of the chorion / placenta or membranes without formation of hematoma. The obtained data are processed by the statistical method using the Microsoft Excel computer program. Results. Stopping bleeding with the use of tranexamic acid averaged over 2 days from the start of therapy, the duration of bleeding was 2.1±0.2 days, whereas in the comparison group, the duration of bleeding was significantly higher than 5.7±0.3 (p<0,01). The need for inpatient treatment was in the main group of 9.7±0.8 bed-days and 15.6±2.7 bed-days, respectively (p<0.05). When using the drug tranexamic acid, the organization and resorption of hematomas in the uterus occurred in a shorter time – 19 of 35 (54.3%) women in the primary group and 10 in 31 (32.3%) women in the comparison group. The total absence of hematoma is noted in the main group for 1.2±0.4 weeks, in the comparison group for 4.8±0.5 weeks (p<0.05). Conclusion. The use of tranexamic acid, as hemostatic therapy in pregnant women with a miscarriage, significantly reduces the duration of bleeding, promotes the accelerating the organization and resorption of intrauterine hematomas, reduces the duration of inpatient treatment. Key words: pregnancy, miscarriage, risk of miscarriage, retrochorionic hematoma, bleeding in the first trimester of pregnancy.