Aim. To determine the level of vitamin D in women with infertility in Kemerovo (Southwestern Siberia). Materials and Methods. We consecutively recruited 98 infertile women and 40 healthy women who applied for the routine examination in our medical center. Serum level of 25-hydroxyvitamin D (alternatively called calcifediol, calcidiol, or 25-hydroxycholecalciferol) was measured by chemiluminescent microparticle immunoassay. Results. Average levels of 25-hydroxyvitamin D in both groups were signficantly lower as compared to the reference values (21.79 ± 1.35 versus 28.03 ± 1.60 ng/mL, respectively, p = 0.001). Notably, women with infertility were more frequently diagnosed with an insufficiency/deficiency of 25-hydroxyvitamin D than healthy women (83.7% versus 60.0%, respectively, p = 0.003). Among these individuals, deficiency of 25-hydroxyvitamin D was more prevalent in infertile women in comparison with insufficiency (51.2% versus 48.8%, respectively), while the reverse was the case in healthy women (17.0% versus 83.0%, respectively).

Aim. To determine the features of metabolic syndrome in women of early reproductive age with polycystic ovary syndrome. Materials and Methods. We recruited 60 consecutive women of early reproductive age, further dividing them into the groups with and without polycystic ovary syndrome (n = 30 per group). Metabolic syndrome was diagnosed by the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III) criteria. Results. Metabolic syndrome was diagnosed in 22 (73.3%) women of early reproductive age with and in 8 women (26.4%) without polycystic ovary syndrome (p = 0.0001). Expectedly, all criteria for the diagnosis of metabolic syndrome were more SHAPE \* MERGEFORMAT English frequently detected in women with polycystic ovary syndrome compared to those without: obesity (p = 0.005), waist-hip circumference ratio > 0.85 (p = 0.049), blood pressure > 140/90 mmHg (p = 0.028), high level of triglycerides (p = 0.0001) and fasting plasma glucose (p = 0.0001) and low level of high-density lipoprotein cholesterol (p = 0.0001). Conclusions. Women of early reproductive age with polycystic ovary syndrome have higher prevalence of metabolic syndrome and its diagnostic criteria as compared to those without.

Aim. To determine epidemiological features and medical consequences of ectopic pregnancy in Kemerovo Region. Materials and Methods. Having collected the relevant data from the statistical records in Kemerovo Region, we analyzed incidence of ectopic pregnancy in 2010-2017 and incidence of ectopic pregnancy-related emergency surgery in 2007-2014 with the subsequent statistical analysis. Results. There was no clear trend to either growth or decline of ectopic pregnancy incidence in Kemerovo Region. The lowest incidence rate was registered in 2015 (32.3 per 1,000 completed pregnancies) while the highest rate was registered in majority of the patients received surgical treatment within the 24 hours after initial diagnosis, yet the proportion of patients who underwent surgery > 24 hours after the diagnosis significantly increased over the study period (13.1% in 2006 and 24.4% in 2017, p = 0.001). Conclusions. Despite the incidence of ectopic pregnancy did not change, the proportion of patients with non-emergency surgery increased twofold. This can be applied in evaluating the efficacy of the Federal Protocol for the Treatment of Ectopic Pregnancy.

Aim. To estimate whether CYP1A1, CYP1A2, CYP19, SULT1A1 gene polymorphisms are associated with genital endometriosis in infertile women. Materials and Methods. We evaluated allele frequencies of aforementioned gene polymorphisms in 100 consecutive women with genital endometriosis-associated infertility and 100 women with tubal infertility utilizing polymerase chain reaction-restriction fragment length polymorphism. Results. We did not find any statistically significant associations between the polymorphisms within the CYP1A1, CYP1A2, CYP19, SULT1A1 genes and genital endometriosis in infertile patients. Conclusions. Further studies are needed to explore the genetic risk factors associated with endometriosis-associated infertility.

Aim. To determine the fatty acid composition of lipids extracted from precancerous lesions and malignant tumors of the cervix. Materials and Methods. We first isolated segments from precancerous cervical lesions and cervical cancer along with adjacent normal tissues. Extraction of lipids from homogenized tissues was performed employing Folch method. Fatty acid composition was evaluated utilizing gas-liquid chromatography. Results. Both precancerous and malignant cervical lesions demonstrated higher levels of saturated and odd-chain fatty acids while having lower levels of mono- and polyunsaturated fatty acids in comparison with adjacent normal tissues. We also detected an increased amount of nonadecylic/ nonadecanoic acid (C_19:0) in cancerous tissues as compared to both precancerous lesions and healthy cervix. Conclusions. Cervical cancer cells are characterized by an impaired lipid metabolism.

Aim. To evaluate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for anesthesia during labor. Мaterials and Methods. We consecutively included 35 patients who received TENS and 35 women who had epidural anesthesia during labor. We further evaluated patient satisfaction with anesthesia, pain intensity, frequency of cesarean or traumatic delivery, duration of labor, and adverse perinatal outcomes. Results. Proportions of patients who were completely satisfied or unsatisfied with anesthesia significantly differed in those who received epidural anesthesia (65.7% and 2.9%, respectively) as compared to TENS (34.3% and 18.8%, respectively). Pain intensity for starting TENS was 3.6 ± 1.3 points according to Visual Analogue Scale. During TENS, pain intensity decreased in 7 (21.9%) patients, stabilized in 11 (34.4%) women and increased in 14 (43.76%) patients. No significant differences between TENS and epidural anesthesia were revealed in terms of duration of labor (380.48 ± 188.88 and 489 ± 178.9 minutes, respectively, p = 0.71), duration of anhydrous period (448.08 ± 507.25 and 485.4 ± 311.2 minutes, respectively, p = 0.95), average dose of anesthetic (79.28 ± 44.79 and 75.71 ± 71.08 mL, respectively, p = 0.97), prevalence of traumatic delivery (40.6% and 51.4%, respectively, р = 0.37), amount of blood loss (245.7 ± 107.8 ml and 214.28 ± 54.21 mL, respectively, p = 0.80), and Apgar scale at 1^st minute (7.6 ± 1.5 and 7.7 ± 0.7, respectively, p = 0.95) or 5^th minute (8.7 ± 1.6 and 8.8 ± 0.8, respectively, p = 0.95). Conclusions. Despite limited efficiency, TENS does not increase risk of traumatic delivery and does not affect perinatal outcomes; hence, it can be considered as a promising anesthesia approach during labor.

Aim. To identify the risk factors of birth injury. Materials and Methods. I retrospectively assessed 262 case histories of labor including 131 cases of birth injury occurred in Omsk during 2008-2016. The control group was formed as a sample of 131 healthy childbirths. Results. Birth injury frequently occurred in patients with pregnancy complications, i.e. intrauterine infection (32.1%), placental abruption (14.5%), intrauterine hypoxia (9.2%), placental insufficiency (19.1%), pre-eclampsia (16.0%), preterm birth (45.0%), postterm pregnancy (6.1%), long anhydrous period (18.3%), premature rupture of membranes (42.0%), labor abnormalities (11.5%), and chronic iron deficiency anemia (15.3%). Conclusions. Risk factors contributing to birth injury are complications of pregnancy (intrauterine infection, placental abruption, intrauterine hypoxia, placental insufficiency, pre-eclampsia, preterm birth, postterm pregnancy), delivery (long anhydrous period, premature rupture of membranes, labor abnormalities), and concomitant disorders (chronic iron deficiency anemia).

Aim. To study the course of pregnancy and labor in patients with labor induction. Materials and Methods. I retrospectively reviewed 216 case histories of women admitted to Podgorbunskiy Regional Clinical Emergency Hospital in 2016, half of which (n = 108) experienced labor induction. Inclusion criteria were 3741 weeks of gestation, induced labor, and singleton pregnancy. Exclusion criteria were preterm birth and cesarean section. Results. Indications for labor induction included exacerbation of somatic disorders (42/108, 38.9%), pre-eclampsia (33/108, 30.6%), postterm pregnancy (27/108, 25.0%), and premature rupture of membranes (16/108, 14.8%) patients. Out of 108 patients with induced labor, only 10 (9.3%) patients had Bishop's score < 6 SHAPE \* MERGEFORMAT while 69 (63.9%) patients had Bishop's score ≥ 8. Further, 10 (9.3%) patients with induced labor had placenta previa, 12 (11.1%) were diagnosed with oligohydramnios or polyhydramnios, and 29 (26.9%) women had impaired fetal heart rate. The most common complications of induced as compared to non-induced labor were traumatic delivery (OR=7,857 (4,15514,856), р=0,038) and labor abnormalities OR=13,549 (4,625-39,693), р=0,045 including weak uterine contractions (OR=12,793 (2,91856,080), р=0,048,and abnormal uterine activity (OR=19,989 (2,609-153,129), р=0,013). Conclusions. Labor induction is associated with traumatic delivery and higher risk of labor abnormalities.

Aim. To study pregnancy course and outcomes in women with low body mass index. Materials and Methods. We analyzed 50 case histories of underweight women who delivered at Reshetova Kemerovo Regional Perinatal Center during 2017. For the comparison, we also investigated 50 case histories of women with normal body mass index. Results. Underweight and healthy women did not differ significantly in terms of age (26.5 ± 3.6 and 27.3 ± 3,7 years, respectively, p = 0.23), primiparity (42% and 30%, respectively, p = 0.19), and past medical history of abortions, vaginal births, or cesarean section. In addition, no significant intergroup differences in prevalence of chorioamnionitis, weak uterine contractions, and abnormal uterine activity were revealed. Women with low body mass index frequently had iron deficiency anemia (22%), neurological disorders (16%), and narrow pelvis (22%). The duration of labor and amount of blood loss during vaginal birth were considerably less in underweight women in comparison to healthy patients (382.9 ± 154.7 versus 455.4 ± 190.8 minutes, respectively, р = 0.04; 193.2 ± 47.0 mL versus 237.5 ± 86.0 mL, respectively, p = 0.002); however, prevalence of placentra previa and traumatic delivery as well as the amount of blood loss during cesarean section were higher in underweight versus healthy women (12% versus 0%, respectively, p = 0.01; 18% versus 4%, respectively, p = 0.03; 607.7 ± 227.0 mL versus 507.1 ± 68.0 mL, p = 0.003). Conclusions. Placenta previa, traumatic delivery, and iron deficiency anemia are significantly more prevalent in underweight women.

The implantation process is very vulnerable and requires a number of conditions: a high degree of synchronism between the endometrium and the embryo, an adequate hormonal environment, normal anatomical conditions and the function of the sex cells. Taking into account the complexity of the process, it is no wonder that frequent implant failures. From a clinical point of view, these failures are becoming an increasingly important problem. Infertility occurs on average for every sixth pair, and this percentage continues to grow.

The identification of cerval intraepithelial neoplasia is of crucial importance for reducing both incidence and mortality of cervical cancer. Currently, screening programs relying on Papanicolaou test or liquid-based cytology are employed in many countries but have a limited efficiency. Recently, HPV genotyping was suggested as a possible screening alternative as high-risk HPV strains are detected in almost all cervical cancer biopsies. Importantly, in addition to high sensitivity, efficient screening approach also requires a wide population coverage. As the main reasons for cervical cancer screening avoidance include fear of examination, embarrassment, and lack of time, self-sampling devices have the potential to significantly improve screening coverage. Such an approach implies invitation for gynecological examination only if high-risk HPV strains would be detected in the self-collected sample. Epidemiological studies demonstrated that results of HPV genotyping in self- and physician-collected samples are comparable; hence, self-sampling devices can be considered for the implementation in cervical cancer screening.

Here we review the epidemiology and screening of breast cancer, a malignant tumor responsible for around 21% of all cancer cases. Risk factors of breast cancer include early menarche, late menopause, overweight/obesity, smoking, alcohol abuse, and genetic presdisposition. Despite the current advances in treatment, in situ breast cancer is rarely diagnosed (1.3%), while 29% of cases are diagnosed at the stage III or IV. Diagnosis of breast cancer is based on medical history, assessment of signs and symptoms, mammography, breast ultrasound examination, and magnetic resonance imaging. Currently, patients with benign breast conditions should be supervised by an obstetrician-gynecologist and receive proper medications. Conservative treatment of benign breast conditions include psychotherapy and use of progesterone, indole-3-carbinol, and Vitex agnus-castus preparations.

Here we review the current data on prevention, diagnosis, and treatment of ovarian cancer, one of the most prevalent genitourinary cancers characterized by high mortality and case fatality rates due to the lack of efficient screening and treatment approaches. Major risk factors of sporadic ovarian cancer include early menarche, late menopause, nulliparity, infertility, endometriosis, polycystic ovary syndrome, use of hormonal contraceptives after menopause, smoking, alcohol abuse, and overweight/obesity. Hereditary ovarian cancer is primarily related to BRCA1/2 mutations and polymorphisms. Progression and outcome of ovarian cancer are largely defined by tumor stage and grade at diagnosis. Importantly, signs and symptoms of ovarian cancer are not specific, and early diagnosis frequently represents an accidental finding. Hence, ovarian cancer is mainly diagnosed at the late stage that significantly affects both overall and disease-free survival. To date, there are no evidence-based screening methods for early detection of ovarian cancer. We propose that implementation of routine genetic testing for BRCA1/2 mutations and polymorphisms in women with family history of ovarian cancer may improve early diagnosis and survival rates.

Here we report a case of a 14-year follow-up for a patient who underwent surgical treatment of obesity (vertical banded gastroplasty) followed by normalization of metabolism, menstrual cycle, and reproductive function.

Surgical scar endometriosis is responsible for 0.4 to 4.0% of all endometriosis cases and represents an ectopic occurrence of the endometrial tissue in scars after uterine surgery. Surgical scar endometriosis can be misdiagnosed as an incisional hernia or inflammatory infiltrate, and the correct diagnosis is often possible only upon the excision of the affected scar tissue. Here we describe a recent case of surgical scar endometriosis diagnosed in a woman who underwent a cesarean section 8 years ago.