Ukrainian Journal of Perinatology and Pediatrics

The relationship between staffing of the obstetrics and gynecology service and indicators of detection of cervical dysplasia in Ukraine

P.Yu. Tokar — 2025-12-28

Cervical dysplasia is one of the leading precancerous pathologies of the female reproductive system and an important marker of the effectiveness of cervical cancer prevention. Timely detection of cervical intraepithelial neoplasia depends not only on biological and behavioral factors, but also on organizational aspects of medical care, in particular, the staffing of obstetrician-gynecologists.

Aim - to assess the relationship between the number of obstetrician-gynecologists and cervical dysplasia detection rates in Ukraine in 2020-2024.

Materials and methods. The research was conducted using official depersonalized statistical data. The material was summarized in tables on the incidence of cervical dysplasia and the number of obstetrician-gynecologists in Ukraine. The analysis covered the period 2020-2024, with 2020 (II-IV quarters) and 2025 (I quarter) considered as incomplete reporting periods. Statistical data processing was carried out using methods of descriptive statistics with the calculation of absolute and relative indicators and the load indicator - the number of cases of dysplasia per doctor.

Results. During the period from 2020 to 2024, the absolute number of registered cases of cervical dysplasia in Ukraine increased from 20,852 in 2020 II-IV quarters to 67,620 in 2024. Mild forms of cervical intraepithelial neoplasia CIN I - 48.0-52.5%, moderate CIN II - 18.9-21.5%, severe CIN III - 8.5-10.3% prevailed in all years, with no pronounced upward trend. Against the background of increasing morbidity, there was a reduction in the number of obstetrician-gynecologists by more than 14%, which was accompanied by an increase in the burden of cervical dysplasia per doctor from 1.9 cases in 2020 to 7.2 cases in 2024.

Conclusions. The results of the study indicate a relationship between staffing of the obstetrics and gynecology service and indicators of cervical dysplasia. A decrease in the number of obstetrician-gynecologists combined with an increase in the burden on doctors can negatively affect the availability and completeness of diagnosis, especially for severe forms of cervical dysplasia.

The author declares the absence of a conflict of interest.

Maternal risk factors in severe newborn asphyxia

V.O. Golyanovskyi — 2025-12-28

Fetal distress during labor is one of the most serious obstetric complications, potentially leading to significant consequences for neonatal health, including hypoxic-ischemic encephalopathy, cerebral palsy, and, in severe cases, perinatal mortality.

Aim - to identify the primary maternal risk factors for severe neonatal asphyxia and to develop a predictive model for the prevention of fetal distress.

Materials and methods. The study included 213 patients. The study group consisted of 98 women whose newborns were diagnosed with severe asphyxia (Apgar score ≤ 3 at the first minute). The control group consisted of 115 patients without a diagnosis of fetal distress. Univariate and multivariate logistic regression models were used to identify the most significant factors.

Results. Univariate analysis revealed an increased risk of fetal distress in the presence of obesity, uterine leiomyoma, preeclampsia, and acute respiratory viral infection (ARVI), while a decreased risk was associated with pre-induction using prostaglandin E₂. Multivariate analysis identified preeclampsia, anemia, ARVI during pregnancy, and labor dystocia as significant risk factors.

Conclusions. The resulting multivariate model demonstrates high predictive power, enabling the development of individualized recommendations for fetal distress prevention. Specifically, preeclampsia, obesity, and acute viral infection are critical factors — in this sample, all cases involving these conditions led to fetal distress. Other factors significantly alter the probability of distress: anemia and labor dystocia significantly increase the risk, while multiparity and thyroid pathology were found to have a protective effect.

The study was conducted according to the principles of the Declaration of Helsinki. The protocol was approved by the Local Ethics Committee of the Kyiv Perinatal Center. Informed consent was obtained from all participants.

The authors declare no conflict of interest.

Clinical, laboratory and statistical analysis of the course of preeclampsia over 10 years

А.V. Chernov — 2025-12-28

Aim - to conduct a retrospective clinical, laboratory and statistical analysis of the course of preeclampsia for 2014-2024 to determine the prevalence of preeclampsia in the population, changes in the frequency and severity of this pregnancy complication over the years, to compare clinical and laboratory indicators to determine the clinical variants of the course of preeclampsia.

Materials and methods. 1379 birth histories with preeclampsia were analyzed: Group I - 1069 pregnant women with moderate preeclampsia and moderate preeclampsia; Group II - 310 pregnant women with severe preeclampsia. The clinical course of the first trimester of pregnancy, gestational age at the time of hospitalization in the maternity ward, general laboratory parameters and clinical symptoms of preeclampsia during the second and third trimesters of pregnancy were studied, namely: hemoglobin level, hematocrit, free bilirubin, platelet count, transaminase level, total protein and fibrinogen level in the blood. Statistical processing of the research results was carried out using standard programs "Microsoft Excel 7.0" and "Statistica 8.0".

Results. Hospitalization dates: up to 26 weeks, 112 (10.5%) pregnant women in Group I were hospitalized against 109 (35.2%) pregnant women in Group II; from 26 to 34 weeks, 394 (36.9%) pregnant women in Group I were hospitalized against 142 (45.8%) pregnant women in Group II; after 34 weeks, 563 (52.6%) pregnant women of Group I were hospitalized compared to 59 (19.0%) pregnant women of Group II; the frequency of premature birth was 121 (39.0%) cases in Group II compared to 203 (18.9%) cases in Group I. In Group II, the following were significantly more frequently observed: hemoconcentration; increased free bilirubin levels (>60 μM/l); thrombocytopenia; increased alanine aminotransferase and aspartate aminotransferase; decreased total blood protein levels (<60 g/l).

Conclusions. A statistical analysis of clinical and laboratory data in pregnant women with preeclampsia over 10 years confirms the presence of two clinical variants of the course of preeclampsia, namely: hemodynamic and cytolytic type.The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of women was obtained for the study.

The author declares that there is no conflict of interest.

Steatometry as a screening method for metabolic-associated steatotic liver disease during pregnancy

A.B. Рrуlutska — 2025-12-28

Aim - to evaluate the possibility of ultrasound steatometry in the detection and staging of hepatic steatosis in pregnant women with risk factors for metabolic-associated steatosis of the liver (MASDL) to optimize the early diagnosis of this nosology in obstetric practice.

Materials and methods. The work used ultrasound examination and liver steatometry on the Samsung Medison V7 ultrasound device in 76 pregnant women, who were divided into groups: I (main) - 46 pregnant women with a burdened somatic history: obesity, type 2 diabetes, hypertension, gestational diabetes, dyslipidemia, and II (control) - 30 healthy pregnant women. New methods of quantitative ultrasound assessment of liver steatosis (QUS) based on Samsung QUS technology were used, where visualization with tissue attenuation - tissue attenuation indices (TAI) and visualization with tissue scattering distribution - tissue scattering index (TSI), percentage of fat fraction in the liver with subsequent statistical processing of the results obtained

Results. It was determined that MASDL occurs in pregnant women with obesity, type 2 diabetes, hypertension, gestational diabetes, and dyslipidemia. Therefore, to reduce the occurrence of obstetric and prenatal complications associated with this pathology, steatometry is recommended in the early stages of pregnancy to identify a high-risk group for the development of MASDL, and this is the goal of our further research.

Conclusions. In pregnant women with a complicated somatic history: obesity, type 2 diabetes, hypertension, gestational diabetes, dyslipidemia, it is advisable to perform liver ultrasound with steatometry in the early stages of pregnancy, which will allow for timely detection of MASDL and determine rational tactics for managing pregnancy, childbirth and the postpartum period, thereby reducing obstetric and perinatal complications.

The study was conducted in accordance with the opinion of the Ethics Committee of the Bogomolets National Medical University, in accordance with the Declaration of Helsinki. Informed consent to participate was obtained from all pregnant women.

The authors declare no conflict of interest.

Anthropometric basis in women with infertility permanently residing in Central Ukraine according to the characteristics of the general adaptation syndrome under conditions of prolonged war

O.O. Berestovyi — 2025-12-28

Chronic psychoemotional and somatic stress under conditions of the prolonged war may influence neuroendocrine regulation in women, leading to changes in anthropometric characteristics and potentially affecting the course of infertility. At the same time, constitutional body features may modulate individual adaptive responses according to the concept of the general adaptation syndrome (GAS).

Aim - to evaluate anthropometric parameters in women with infertility who permanently resided in central Ukraine during the prolonged war from the perspective of the GAS concept.

Materials and methods. A prospective observational study was conducted involving 81 women of reproductive age diagnosed with infertility. The main group consisted of 50 women with infertility residing in central Ukraine since 2022, the control group - 31 women without fertility disorders (historical control). Somatotype (Heath-Carter method) and body composition components (Matiegka method) were assessed together with stress level (Holmes-Rahe Stress Scale), anxiety (Beck Anxiety Inventory). GAS phases were determined using the adaptation coefficient.

Results. The majority of women in the main group were in the resistance phase of GAS (66.0%), while the adaptation phase was observed in 30.0% and the exhaustion phase in 4.0%. Low stress-associated disease risk was found in 60.0%, moderate in 30.0%, high in 10.0%. Women with high risk had higher body mass, fat and bone components, endomorphy and lower body water percentage (p<0.05), as well as a significantly reduced muscle component compared with the control group (16.24±2.20 vs 20.81±1.99; p<0.001). Correlation analysis revealed moderate associations between anxiety scores and anthropometric parameters. No statistically significant differences were observed between GAS phases.

Conclusions. Body composition and somatotype may serve as morpho-constitutional markers of individual adaptive response to chronic psychoemotional stress. The predominance of the resistance phase indicates preserved adaptive reserves.

The study was conducted according to the principles of the Declaration of Helsinki. The Local Ethics Committee of the Perinatal Center approved the protocol of the study. Informed consent of women was obtained for the study.

The authors declare no conflict of interest.

Fetal motor activity under the influence of dangerous wartime factors

S.R. Galych — 2025-12-28

Wartime events associated with intense psycho-emotional stress, which may affect the course of pregnancy and fetal development. Fetal motor activity is an important marker of functional status and a potential indicator of response to stress factors.

Aim - to assess the characteristics of fetal motor activity in fetuses with a gestational age over 22 weeks under conditions of dangerous wartime events in order to optimize perinatal care.

Materials and methods. The study included 138 pregnant women. Fetal motor activity was assessed based on maternal reports obtained through a questionnaire regarding changes in fetal movements during wartime events. Ultrasound examinations were not performed for ethical reasons, as women were staying in bomb shelters during shelling. The following types of changes in motor activity were identified: no change, increased activity, decreased activity, and delayed activity. Statistical analysis was performed using Pearson’s χ² test, with the level of significance set at p<0.05.

Results. In 63.0% of cases, no changes in fetal motor activity were reported. In 37.0% of observations, various types of changes were recorded: increased motor activity in 19.6%, decreased activity in 8.0%, and delayed activity in 9.4% of cases. Analysis according to gestational age revealed variability in fetal responses, most pronounced at 22-30 and 31-36 weeks of gestation.

Conclusions. The obtained data indicate that fetal motor activity is a sensitive indicator of the impact of extreme maternal stress under wartime conditions. Maternal questionnaires can be considered a feasible and ethically acceptable method for assessing fetal condition in crisis settings and have practical value for perinatal monitoring.

The author declares the absence of a conflict of interest.

Optimization of the management of the third stage of labor and early postpartum period in women with uterine leiomyoma

I.M. Morokhovets — 2025-12-28

Aim - to optmize the management of the third stage of labor and the early postpartum period in women with uterine leiomyoma through the implementation of a modified preventive algorithm.

Materials and methods. A prospective study was conducted involving 120 women with term pregnancy and uterine leiomyoma (types 3-5 according to the International Federation of Gynecology and Obstetrics classification with nodules larger than 5 cm). The participants were divided into two groups: Group І - 60 women who received standard management of the third stage of labor and the postpartum period in accordance with the protocols of the Ministry of Health of Ukraine; Group ІІ - 60 women who received the proposed algorithm (intravenous administration of 1 g tranexamic acid during the third stage of labor and remodeling of the lower uterine segment in the early postpartum period). The study compared the following indicators: the volume of blood loss during childbirth and during the early postpartum period, the frequency of postpartum bleeding (more than 500 ml), the dynamics of hemoglobin levels before childbirth and within 5 days after childbirth, and indicators of uterine involution in the postpartum period.

Results. In women of Group 2, a reduction of up to 30% in the mean blood loss was observed, along with a threefold decrease in the incidence of postpartum hemorrhage, significantly higher hemoglobin level in the postpartum period (p<0.05) and faster uterine involution compared to standard management.

Conclusions. The proposed algorithm significantly reduces the frequency and severity of postpartum hemorrhage in women with uterine leiomyoma. The combination of tranexamic acid and lower uterine segment remodeling represents an effective preventive strategy for patients at high obstetric risk. The implementation of this approach allows to increase the effectiveness of primary prevention of obstetric bleeding in women with uterine leiomyoma without the use of uterotonic agents and without the need for other invasive interventions.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee. Written informed consent was obtained from all participants.

The authors declare no conflict of interest.

Population-based model for implementing personalized medicine in pediatric practice within a capable healthcare network

L.O. Turova — 2025-12-28

Aim - to develop and scientifically substantiate a population-based model for the implementation of personalized medicine in pediatric practice within a capable healthcare facility network.

Materials and methods. An organizational and analytical study was conducted using a systemic analysis of the regulatory framework governing the formation of a capable healthcare network, a comparative analysis of international experience in integrating genomic medicine, and structural modeling. A multilevel model for the integration of genetic predictors into pediatric practice was developed.

Results. A three-tier organizational model (primary, cluster, and supercluster levels) was established to ensure the phased integration of genetic predictors into pediatric healthcare delivery. A population-based algorithm for family genetic support was developed, covering the continuum from the preconception period to the postnatal stage. The model incorporates risk stratification, the development of individualized preventive care pathways, and the establishment of regional registries.

Conclusions. The proposed model enables the systematic integration of personalized approaches into pediatric care, facilitates the early identification of genetic risks, and provides a foundation for reducing long-term morbidity and optimizing healthcare resources.

The author declares no conflict of interest.

Age- and sex-specific morphometric parameters of the phalanges in preschool children

I.G. Biryuk — 2025-12-28

Radiographic examination of the skeletal system provides extremely valuable evidence to study the evolution of the child’s body, to assess its age-related morphological differentiation, and allows detection of developmental defects.

Aim - to determine the age- and sex-specific morphometric parameters of the phalanges of the right and left hands in children aged 4-7 years to identify the developmental patterns of their topography at this age.

Materials and methods. The study of morphometric parameters of the phalanges of the fingers of the right and left hands was based on a retrospective examination of 179 radiograms of children of both sexes (83 boys and 96 girls) aged 4-7 years. The research was conducted under standard conditions based on the Department of Pediatric Traumatology of Chernivtsi Emergency Hospital according to the agreement on cooperation.

Results. The study revealed heterochronous growth of the phalanges in children aged 4-7 years. In the first digit of the right hand, the distal phalanx grows actively at 4-5 years, and the proximal phalanx at 6-7 years; in the left hand, both phalanges show peak growth at 5-6 years. In the second digit, the proximal phalanges of both hands elongate intensively at 6-7 years, the middle phalanges at 4-5 years, while the distal phalanges grow uniformly throughout the period.

For the third and fourth digits of the right hand, accelerated growth of the middle and distal phalanges is characteristic at 4-5 years, and the proximal ones during the 5-7 year period. On the left hand, the growth of all phalanges in these digits is synchronized and occurs mainly at 5-6 years. In the fifth digit, the middle phalanges of both hands grow actively at 5-6 years. The proximal and distal phalanges of the little finger demonstrate complex bilateral and sex-specific differentiation: in boys, growth peaks are shifted toward 5-7 years, while in girls, intensive growth is recorded earlier, between 4 and 6 years.

Conclusions. Accelerated growth of the hand bones in preschoolers most frequently occurs at 6 years of age, with the most pronounced dynamics observed in the phalanges of the third digit. A distinct age-related bilateral asymmetry in phalangeal length was established, reflecting individual and sex-specific patterns in the topographical development of the hand skeleton during this age period.

The study was conducted according to the principles of the Declaration of Helsinki. The Local Ethics Committee of Chernivtsi Emergency Hospital approved the protocol of the study. Informed consent was obtained from the parents of children in order to conduct the study.

The author declares no conflict of interest.

Post-transplant complications in children with congenital cholestatic liver diseases

H.V. Kurylo — 2025-12-28

Orthotopic liver transplantation (OLT) remains the only radical treatment for end-stage liver failure in children with congenital cholestatic liver diseases. The main indications include biliary atresia, Alagille syndrome, and other inherited cholestatic syndromes. Despite advances in surgical techniques and postoperative care, the risk of early and late complications remains high, particularly in children weighing <10 kg.

Aim - to evaluate the incidence, structure, and timing of post-transplant complications in children with congenital cholestatic liver diseases after orthotopic liver transplantation (OLT), as well as to identify risk factors for their development.

Materials and methods. A retrospective single-center study was conducted on 54 children who underwent primary OLT for congenital cholestatic liver disease. The mean age at transplantation was 1.4±1.0 years, and the mean body weight was 17.9±14.4 kg. Transplants were performed from living related donors (88.9%) or deceased donors (11.1%), using left lateral segment, reduced, or monosegment grafts. Early complications were defined as those occurring within 90 days post-transplant, while late complications occurred after 90 days. Descriptive statistical analysis was applied.

Results. The most common indication was biliary atresia (81.5%). Early complications included acute graft rejection (40.7%), infectious complications (31.5%), and surgical or biliary complications (11.1% each). Late complications included graft fibrosis (59.3%), neurological complications (11.1%), metabolic/endocrine disorders (5.6%), and post-transplant mortality (3.7%). Overall patient survival exceeded 94%.

Conclusions. Orthotopic liver transplantation in children with congenital cholestatic liver diseases is safe and effective. Living related donors and tailored graft types allow transplantation even in children with low body weight. The significant risk of early and late complications highlights the need for long-term postoperative monitoring and multidisciplinary follow-up.

The authors declare that there is no conflict of interest.

Cervical-isthmical pregnancy. A clinical case report

Y.M. Vitovskiy — 2025-12-28

Ectopic pregnancy is a condition in which implantation and development of a fertilized egg occurs outside the uterine cavity and is one of the life-threatening conditions for a woman's life and reproductive health. In clinical gynecology, it is customary to distinguish distal forms of ectopic pregnancy (cervical and cervicocervical) and proximal forms (tubal, abdominal, ovarian). Cervical and cervicocervical pregnancy, among various variants of ectopic pregnancy, occurs with a frequency of between 1:8,600 and 1:12,400 cases of the total number of all pregnancies and less than 1% of the number of ectopic pregnancies.

Aim - based on a clinical case, analyze the difficulties of diagnosing cervicovaginal pregnancy to expand doctors' knowledge of this pathology.

A clinical case of cervicocervical pregnancy at 31 weeks of gestation, which ended with a cesarean section with a viable baby and extirpation of the uterus, is described. In a true cervical pregnancy, the fetal container is the cervical canal, and in a cervicocervical localization, the cervix and the isthmus area. Cervical pregnancy poses a threat to the woman's life: the main danger and cause of death in 75-85% of cases is profuse bleeding. A feature of this clinical case is that the diagnosis can be made only during delivery, due to the difficulties of clearly localizing implantation and imitating the clinical picture of placenta previa. A detailed description of the delivery is given, outlining the difficulties of access.

Conclusion. The presented clinical case is an illustration of a difficult-to-diagnose case, where a cervicocervical pregnancy imitates a uterine pregnancy with placenta previa. Practical recommendations for physicians regarding the choice of the site of uterine incision for fetal extraction are provided.

The study was performed in accordance with the principles of the Declaration of Helsinki. The patient's informed consent was obtained for the publication of the case report.

The authors declare that there is no conflict of interest.

Thrombosis and hematoma of umbilical cord vessels: their role in perinatal complications

N.M. Shemyakina — 2025-12-28

Umbilical cord pathology is a common cause of perinatal complications, including asphyxia, stillbirth, and neonatal mortality. Certain forms, such as thrombosis of the umbilical arteries or vein and hematoma, are rare but are associated with a high risk of severe hypoxia and adverse perinatal outcomes. Although prenatal diagnosis of these conditions is possible with umbilical cord pathology, in most cases, the pathology is only detected intra- or postnatally.

Aim - to investigate the spectrum of umbilical cord pathologies as a risk factor for lethal pregnancy complications, to clarify the clinical significance of specific anomalies, and to identify early diagnostic pathways for improving pregnancy and labor management protocols.

Clinical case. A 29-year-old pregnant woman, gravida 1, had a physiological pregnancy course. During labor, she developed acute fetal bradycardia, which required an emergency cesarean section. A boy was born in a state of severe asphyxia (Apgar 3/4), with subsequent development of convulsive syndrome and hypoxic-ischemic encephalopathy. During delivery, a double nuchal cord, umbilical cord hematoma, and umbilical vein thrombosis were found. The newborn received therapeutic hypothermia, intensive care, and anticonvulsant therapy. The infant was discharged on day 16 in a satisfactory condition with subsequent normal development. Histological examination confirmed the presence of umbilical vein thrombosis and hematoma. The mother was found to have homozygous thrombophilia gene mutations. Umbilical cord pathology can significantly affect fetal development and the course of labor. Vascular thrombosis and umbilical cord hematoma are associated with a high risk of severe asphyxia and stillbirth. Antenatal diagnosis is often difficult, which is why clinical alertness and readiness for an emergency delivery are crucial. This case demonstrates a combination of two rare umbilical cord pathologies (umbilical vein thrombosis and hematoma) that led to acute fetal distress and neonatal asphyxia. However, due to a timely cesarean section and modern intensive care, a fatal outcome was avoided.

Conclusions. Umbilical cord thrombosis and hematoma are rare but potentially lethal complications of pregnancy. Timely detection of changes in the fetal condition during labor monitoring and prompt reaction from medical staff determine the prognosis for the newborn. Further research is needed to clarify the role of umbilical cord pathology in the structure of perinatal mortality and the possibilities for its early diagnosis.

The study was performed in accordance with the principles of the Declaration of Helsinki. The patient's informed consent was obtained for the publication of the case report.

The authors declare that there is no conflict of interest.

Maternity and childhood care in Ukraine: status, challenges and prospects

R.O. Moiseenko — 2025-12-28

Aim - to analyze of current data on the status, challenges and prospects of maternity and childhood care in Ukraine, in particular analysis of the regulatory framework.

Domestic regulatory documents and international documents that are the basis for the formation of state policy on maternity and childhood care in Ukraine are considered. 9.5 million people in Ukraine are at risk of or living with a mental disorder, of whom 3.9 million suffer from symptoms ranging from moderate to severe. In view of this, the “Action Plan for 2024-2026 on the Implementation of the Concept of Mental Health Development in Ukraine for the Period up to 2030” requires significant additions. Negative trends in the health of children in Ukraine are doubly concerning in connection with the crisis demographic situation. Ukraine is considered one of the countries with the lowest birth rates in the world. The birth rate in 2021, before the full-scale invasion, was 1.16 per woman of childbearing age. The demographic situation in Ukraine required the development of a long-term consistent policy. A significant step in this regard was the adoption of the extremely important document “Strategy of Demographic Development of Ukraine for the Period up to 2040” and “Action Plan for the Implementation of the Strategy of Demographic Development of Ukraine for the Period up to 2040 in 2024-2027”. An important step towards fully addressing disability issues in Ukraine was the approval of the International Classification of Functioning, Disability and Health (ICF) as the National Classifier. In April 2022, the National Classifier of Functioning, Disability and Health (NC 030:2022) was adopted in Ukraine. The state of reproductive health of women in Ukraine is characterized by unsatisfactory indicators of infertility, miscarriage, incidence of sexually transmitted infections, oncological pathology of the reproductive organs, etc.

Conclusions. The results of the analysis indicate a number of problems in the organization of medical care for children and mothers and require urgent solutions at the state, sectoral and regional levels.

No conflict of interest was declared by the authors.

Endometriosis: current perspectives on etiology, pathogenesis, and molecular mechanisms of disease development (literature review)

O.Yu. Kostenko — 2025-12-28

Endometriosis (EM) is a multifactorial, estrogen-dependent chronic inflammatory disease characterized by the growth of endometrium-like cells outside the uterine cavity.

Aim - to summarize the main hypotheses of EM development based on current literature.

A narrative review of PubMed, Scopus, Web of Science, and Google Scholar publications (2000-2025) was conducted. Included were original studies, systematic reviews, meta-analyses, and international guidelines on EM pathogenesis. Excluded were duplicates, low-evidence studies, and off-topic publications. Literature was categorized by theories: retrograde menstruation, metaplastic, immunological, genetic, hormonal, inflammatory, and epigenetic. Current concepts - the immunological, inflammatory, genetic, and epigenetic theories - explain mechanisms of EM survival, growth, angiogenesis, and progression. The hormonal theory emphasizes hyperestrogenism (elevated estrogen) and relative progesterone resistance. The genetic theory highlights hereditary predisposition and mutations in ESR1 and ESR2 (estrogen receptors), VEGF (vascular endothelial growth factor), KRAS and WNT4 (regulation of cell growth and invasion), and HLA-G (immune tolerance). Immunological dysfunction supports survival of ectopic lesions through impaired macrophage and regulatory T-cell activity. The most promising approach is an integrative model combining retrograde cell transport, immune dysfunction, hormonal imbalance, genetic susceptibility, and epigenetic modifications.

Conclusions. EM is a polyetiologic disease. An integrative approach provides a foundation for the implementation of individualized diagnosis and molecularly targeted therapy.

The authors declare that there is no conflict of interest.

Assessment and surgical management strategy for isthmocele following cesarean section

K.V. Chayka — 2025-12-28

In modern gynecology, isthmocele (cesarean scar defect - CSD) has evolved from an "incidental finding" to a clinically significant pathology requiring a clear diagnostic and therapeutic algorithm. Literature data from 2019-2024 highlight a direct correlation between Cesarean section techniques, specifically low uterine incision and suturing methods, and defect formation. Key clinical challenges include abnormal uterine bleeding in up to 85% of cases, secondary infertility, and chronic pelvic pain.

Aim - to develop a stratification algorithm for the surgical treatment of isthmocele based on ultrasound criteria for residual myometrial thickness (RMT) and the patient's clinical presentation.

A comprehensive examination for patients with CSD has been developed. It was found that ultrasonography is the primary diagnostic tool for determining the morphological parameters of the niche. RMT was identified as the key indicator. It was demonstrated that clinical symptomatology correlates with the dimensions of the defect: abnormal uterine bleeding was observed in the majority of patients (37-85%), while infertility and pelvic pain were identified in 11-39% and 18-33% of cases, respectively. A differentiated management approach has been proposed: conservative observation is recommended for patients with an asymptomatic defect, regardless of the niche size. In cases of severe symptoms and large defects, surgical correction is indicated. The feasibility of laparoscopic metroplasty was determined for cases where the RMT exceeded 3 mm. This approach allowed not only for the elimination of the niche but also for the reinforcement of the uterine wall, significantly reducing the risk of complications compared to isolated hysteroscopic resection.

Conclusions. Successful treatment of isthmocele depends on the standardization of ultrasound criteria and a multidisciplinary approach. Stratifying patients based on RMT measurements allows for the selection of an optimal strategy - ranging from a "wait-and-watch" approach to minimally invasive laparoscopic correction. Implementing laparoscopic access when the myometrial thickness is >3 mm is a pathogenetically sound method that ensures the restoration of anatomical integrity and improves reproductive outcomes.

The authors declare that there is no conflict of interest.

The relationship between the formation of social health and socialization of Ukrainian adolescents from among internally displaced persons

O.P. Yefremova — 2025-12-28

The process of forming social health and socialization of adolescents from internally displaced persons (IDP) should be considered as a complex psychological pedagogical problem. The formation of social health and socialization of this category of adolescents requires comprehensive and coordinated work of specialists in social, educational, and medical fields (social educators, social workers, psychologists, doctors, and teachers). Specialists provide multidisciplinary support to adolescents from IDP, conduct diagnostics, and provide recommendations and assistance in accordance with the needs of this category of adolescents.

Aim - to conduct a systematic analysis of scientific sources on the process of forming social health and socialization of Ukrainian adolescents from among IDP.

Adolescents from IDP face emotional deprivation, increased anxiety, and difficulties in establishing contacts with classmates and teachers of educational institutions. This complicates their integration process. The relationship between the formation of social health and socialization of Ukrainian adolescents from among IDP requires the use of various working forms that will help involve them in the educational process. Social specialists who accompany adolescents from among IDP should motivate them to undergo official registration. This legitimizes their status as an IDP and opens access to a wide range of support (social, legal, material assistance from state and charitable organizations, provision of social, psychological and medical services). A pressing problem for the formation of social health and socialization of Ukrainian adolescents from among IDP is psychological encapsulation. Psychological encapsulation is a protective mechanism of the psyche of adolescents who have experienced or are experiencing trauma, stressful situations.

The relationship between the formation of social health and successful socialization of adolescents from families of IDP depends on the acceptance of social status in a new environment, the process of psychological satisfaction with integration, educational activities, successful communication in the educational institution, organization of routine, a high level of social support from teachers and classmates.

The authors declare the absence of a conflict of interest.