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Назначение скорректированной поддерживающей гормональной терапии в ранние сроки индуцированной беременностиодно из наиболее эффективных средств, способствующих снижению репродуктивных потерь. Цель работы-усовершенствование поддерживающей гормональной терапии в ранние сроки индуцированной беременности у пациенток с эндокринным бесплодием различного генеза в анамнезе. Материалы и методы. У 44 женщин с индуцированной одноплодной беременностью и ановуляторным бесплодием в анамнезе и у 20 здоровых беременных проводили ультразвуковой и гормональный мониторинг I триместра беременности. В зависимости от динамики гормональных изменений пациенткам с индуцированной беременностью назначали корректирующую гормональную терапию. Основным критерием эффективности лечебных мероприятий считали пролонгирование беременности до 12 недель. Статистическую обработку проводили с применением пакета программ StatSoft «Statistica» v.6.0, Microsoft Excel XP. Результаты. Несмотря на экзогенное введение гестагенов, в группе женщин с ановуляторным бесплодием в анамнезе установлена высокая частота угрозы выкидыша (47,7 %), патологии хориона (29,5 %), прерывания беременности (27,3 %). У пациенток с прерванной беременностью с гипоталамо-гипофизарной недостаточностью (ГГН) гормональный мониторинг показал изначально низкий уровень β-субъединицы хорионического гонадотропина (β-ХГ), нормальный уровень прогестерона (П), однако неадекватный прирост β-ХГ и П в динамике; у пациенток с гиперпролактинемией (ГПРЛ)-сверхвысокие концентрации П, нормальный уровень β-ХГ в ранние сроки беременности и постепенное снижение их уровня в течение І триместра; у пациенток с гиперандрогенией (ГА)-сверхвысокие концентрации П в начале и прогрессирующее их снижение в течение І триместра, недостаточный прирост β-ХГ с начала исследования, сочетавшийся с повышенным уровнем андрогенов-дегидроэпиандростерона сульфата и/или свободного тестостерона.

Asymptomatic bacteriuria refers to the category of pathological conditions that are caused by infection in the urinary tract and are in particular importance for pregnant women, as in the case of late diagnosis or inadequate treatment in 20,0-40,0 % of cases they realizes in gestational pyelonephritis and becomes one of the factors of the development of intrauterine infection. The usage of the herbal remedy Nefrokea in the treatment of asymptomatic bacteriuria helpes to reduce the incidence of pyelonephritis and associated obstetric complications.

The document was approved at an expanded meeting of the Ukrainian Society of Gynecological Endocrinology with the involvement of all board members and representatives of the Association of Obstetricians-Gynecologists of Ukraine, the Association of Pharmacologists of Ukraine, the Association of Anesthesiologists of Ukraine, as well during the Third Ukrainian School of Gynecological and Reproductive Endocrinology with international participation ISGE 19–20.03.21.The COVID-19 pandemic has significantly impacted medical practice, in terms of organizational and clinical practices, posing a number of complex and contradictory challenges for professionals.This document is the result of the systematization of scientific data available by March 2021 and recommendations of international medical and specialized professional societies on controversial clinical issues in gynecological practice caused by the COVID-19 pandemic, as well as certain issues of safety and ratio of using hormonal drugs. The involvement of experts from professional associations of the obstetric and gynecological field, pharmacology, anesthesiology and vascular surgery and phlebology in the working group made it possible to formulate clinically justified provisions of the position.The position includes three thematic sections: “On the use of estrogen-containing combined hormonal contraceptives (CHC) during the COVID-19 pandemic”; “On the use of menopausal hormone therapy (MHT) during the COVID-19 pandemic”; “On the issue of unregistered compounded bioidentical hormones”. At the beginning of each thematic section, the main conclusions of the consensus position of professional medical associations are presented. According to the data available by March 2021, there is no reason to limit the use of CHC or MHT in healthy women (currently not having COVID-19). The question of CHC or MHT discontinuing or switching to other forms by women with COVID-19 should be decided depending on the severity of the disease, the total set of risk factors for thromboembolic complications and other individual characteristics of the clinical situation. Further research will provide elaboration of more detailed algorithms. Physicians need to be vigilant about the safety of compounded Bioidentical Hormonal Therapy (cBHT) in any dosage form (including pellets), especially during the COVID-19 pandemic, given the unexplored systemic effects and therefore the potential risks. Preference should be given to officially licensed medicinal products with a well-studied safety profile and clinical effects, the use of which is authorized by doctor's prescription and supported by clinical protocols and guidelines.

Pregnancy-associated renal thrombotic microangiopathy is a rare condition with poor maternal outcome. Pregnancy may trigger atypical hemolytic uremic syndrome or thrombotic thrombocytopenic purpura. The article describes the clinical case of a 37-year-old woman who developed acute renal failure following complicated delivery. A turn-based differential diagnosis of atypical hemolytic uremic syndrome was performed. Unwarranted discontinuation of the targeted therapy with Eculisumab led to the development of chronic renal failure. Pregnancy-associated atypical hemolytic uremic syndrome is a life-threatening condition rarely seen in pregnancy making its early recognition difficult. As thrombotic microangiopathies require urgent treatment, plasmapheresis should be started as soon as they are suspected, followed by Eculisumab after the confirmation of the diagnosis of atypical hemolytic uremic syndrome. This may contribute to reducing maternal morbidity and mortality rates.

Objectives: To study the association of second trimester uterine artery Doppler (PI) pattern with adverse maternal and fetal outcome. Methods: Prospective cohort study involving 100 singleton, uncomplicated gestations between 18-28 weeks of gestation, attending the ante-natal clinic of Department of Obstetrics and Gynaecology in Amrita Institute of Medical Sciences, Kochi, a tertiary care centre in Kerala, Southern India from July 2017 and September 2020. Approval from the Institutional Ethics committee was obtained. Patient details, complications and neonatal outcomes were obtained from the hospital's electronic medical records. Uterine artery Pulsatility index (PI), the most commonly used index was done routinely with second-trimester (anomaly) scan. It is considered to be abnormal if above the 90th centile for the gestational age. Results: Of 100 samples, 15% were subject to hypertensive disorder, 7 % fetal growth restriction (FGR) and 7% spontaneous preterm labour. Abnormal PI was found in 13 pregnancies. 69.2% of this was complicated by hypertensive disorders (p = 0.001). Sensitivity and specificity was 60% and 95.3% respectively. 23.1% had FGR (p = 0.064) with sensitivity of 44.4% and specificity of 90%. 38.5% had preterm birth (32-37 weeks) (p = 0.051). Out of the 100 neonates, 94% of the neonates had APGAR≥7. 12% of the total required immediate NICU admission for various factors. No statistically significant association between uterine artery PI and spontaneous preterm labour (p = 1.00), neonatal birth weight (p = 0.3), APGAR score at birth (p = 0.36) and NICU admission (p = 0.076). Conclusions: Uterine artery Doppler is not only an inexpensive and non-invasive modality, but also becoming quite popular in developing countries as routine practice. The findings from this study certainly have potential clinical implications with the use of second trimester uterine artery Doppler for the management of high risk pregnancies especially with hypertensive disorders, FGR and preterm birth with good sensitivity and specificity.