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Background. A significant proportion of couples worldwide suffer from infertility associated with polycystic ovary syndrome (PCOS). PCOS is characterized by increased androgen synthesis in the theca cells of the ovaries, hyperandrogenemia and ovarian dysfunction in women. Most of the clinical symptoms and altered levels of blood biomarkers in PCOS patients point to metabolic dysregulation and adaptive changes as key underlying mechanisms of disease development. Since the liver is the metabolic center of the body and participates in steroid-hormonal detoxification, pathological changes in it can contribute to endocrine disorders through the liver-ovary axis. Of particular interest is hyperglycemia, changes in secretory proteins of the liver and insulin sensitivity, which affect the maturation of ovarian follicles and can potentially lead to female infertility. Objective of the review: to provide an understanding of the new metabolic mechanisms underlying PCOS, which lead to the disease and its exacerbation, as well as to summarize therapeutic approaches to the correction of PCOS complications, in particular, liver function disorders using the drug Hepatomunil. Analysis of literary data. This review presents the relationship and underlying mechanistic basis between PCOS and metabolic disorders in women by summarizing the main pathologic features of the disease. Most symptoms of PCOS are associated with insulin resistance, type II diabetes, decreased levels of sex hormone-binding globulin, increased levels of alanine aminotransferase and aspartate aminotransferase, which may indicate liver dysfunction. The metabolic profile and function of the ovaries can be affected by any pathological changes in the levels of systemic metabolism and/or in peripheral organs, in particular the liver, which serves as the metabolic center of the body, mediating its effects through the liver-ovary axis. Conclusions. Despite the lack of a clear protocol for the correction of liver function disorders and non-alcoholic fatty liver disease in PCOS patients, lifestyle modification should be the basis. Drugs that improve metabolism, as well as hepatoprotectors with immunomodulatory properties (the drug Hepatomunil) may have positive prospects for use. [ABSTRACT FROM AUTHOR]

Today, there is an urgent need to develop and implement a regulatory document on abortion. This is due to the catastrophic state of reproduction of the Ukrainian population – the annual decrease in the number of labor, birth rates and the demographic crisis in Ukraine in general. Pregnancy loss not only causes obstetric complications, but also causes significant damage of the mental health of the woman and her partner, including depression and post-traumatic stress disorder. This resolution is a joint position of the leading specialists of Ukraine on the issue of miscarriages based on domestic experience, results of randomized controlled trials and meta-analyses, as well as clinical recommendations of scientific societies of the world. The presented information is designed to help improve clinical approaches to the management of miscarriage in today’s conditions, in order to save every pregnancy and to not lose a baby. During the Forum, the practical issues of diagnosis and treatment of miscarriage, modern management of threatened and habitual miscarriage, hormonal support of pregnant women and the use of progestogens, the influence of the first half of pregnancy on the birth of a healthy child, the impact of liver diseases on the choice of therapy in a pregnant woman, and others issues were considered. World clinical experience has convincingly proven the high effectiveness of progestogens in the therapy of threatened and repeated miscarriages. However, not all progestogens are equally effective in reducing the risk of miscarriage and live birth in case of threatened miscarriage. Micronized progesterone and dydrogesterone are the most effective. Dydrogesterone differs from progesterone in its mechanism of action and affinity for progesterone receptors. A strong evidence base has been accumulated about a high profile of effectiveness and a low frequency of maternal and fetal complications for dydrogesterone, the use of which is approved by leading foreign associations. Drug interactions and their effects on the liver should also be taken into account. Drugs that are indicated for pregnant women should be prescribed in the smallest therapeutic dose, which should be effective. [ABSTRACT FROM AUTHOR]

The objective: to evaluate the clinical effectiveness of L-arginine in the prevention of preeclampsia and reduction of other perinatal risks in patients with preclinical gestational endotheliopathy (GE). Materials and methods. A comparative clinical study was performed at the clinical base of the Department of Obstetrics and Gynecology N. 1 of the Vinnytsya National Pirogov Memorial Medical University. 116 pregnant women with preclinical GE (main group), which was diagnosed by laboratory and instrumental research (microalbuminuria and endothelium-dependent vasodilatation), took part in the study. The patients of the main group were divided into clinical subgroups: 31 pregnant women with GE in subgroup A received acetylsalicylic acid (ASA) at a dose of 75 mg per or per day; 33 patients with preclinical GE from subgroup B received L-arginine at a dose of 4-4.2 g per or per day; 52 pregnant women with preclinical GE who refused prophylactic treatment were included in the subgroup C. The control group involved 58 pregnant women with a physiological gestation and without GE. The clinical effectiveness of the therapy was assessed by comparing the number of cases of perinatal pathology in the I, II and III trimesters. Results. The use of L-arginine as an alternative preventive therapy for the development of preeclampsia and other perinatal pathology made possible to reduce the rate of preeclampsia significantly (RR 0.19, 95% CI: 0.05-0.77; p=0.02) and placental hyperplasia/hypoplasia (RR 0.17, 95% CI: 0.04-0.68; p=0.01), compared to patients who did not receive any preventive treatment. In pregnant women with early-onset gestational endotheliopathy who received L-arginine, placental dysfunction was not diagnosed in the II and III trimesters of pregnancy and there were no cases of fetal growth retardation. The use of L-arginine was not associated with side effects and/or adverse reactions in the proposed dose and frequency of administration and can be considered beneficial for the mother and the fetus. Conclusions. Prescribing ASA and L-arginine drugs for pregnant women with a moderate degree of perinatal risk (preclinical GE) made possible not only to prolong pregnancy, but also to prevent the development of severe perinatal pathology. A more pronounced clinical effectiveness of the course prescription of solution of L-arginine per or (daily dose of L-arginine - 4.0-4.2 g) in pregnant women with preclinical form of GE may be associated with the endotheliotropic protective effect of the drug. The appropriateness of using L-arginine during pregnancy is still debated, and further researches are needed to determine the optimal dosage, initial period for using and duration for the best prophylactic or therapeutic effect. [ABSTRACT FROM AUTHOR]

Although, nausea and vomiting in early pregnancy is very common, affecting approximately 80% of pregnancies, hyperemesis gravidarum (HG) is a severe form that complicates up to 2.2% of pregnancies. HG is one of the most common indications for hospitalization during pregnancy. In addition to the insufficient nutrition both for the mother and fetus, the severity of HG symptoms causes a serious psychosocial stress, which leads to depression, anxiety and even the development of perinatal pathology. The aim of this meta-analysis was to study available randomized controlled trials about therapeutic strategies by HG, their evaluation based on both subjective and objective measures of efficacy, maternal and fetal/neonatal safety, and economic costs. A systematic data search was conducted using the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and publications in professional editions of Ukraine for 2013–2023. The search was conducted using the following keywords: pregnancy, nausea and vomiting of pregnant women, excessive vomiting of pregnancy, hyperemesis, antiemetic therapy during pregnancy, infusion therapy and the safety profile of medications prescribed during pregnancy in various combinations. The main outcome was: the effectiveness of therapeutic strategies (reduction or stopping nausea/vomiting); detailing by safety profile of antiemetic drugs; optimization of infusion therapy; additional clinical strategies that help to improve the quality of care for pregnant women; adverse effects and side effects of drugs for HG for the mother/fetus/newborn. The results presented in this meta-analysis can be used in the creation of a national clinical guideline, protocol, consensus or clinical recommendations regarding the clinical management of hyperemesis gravidarum. [ABSTRACT FROM AUTHOR]

Nausea and vomiting, or early toxicosis, is a common disorder during pregnancy, affecting up to 80% of pregnant women. The severe form is known as excessive vomiting of pregnancy – hyperemesis gravidarum (HG) and is a debilitating and potentially life-threatening illness during pregnancy which is characterized by persistent nausea and/or vomiting, weight loss, malnutrition and dehydration, increases the risk of adverse maternal and perinatal outcomes. Without the methodical intervention of experienced clinicians, life-threatening complications can develop. Effective prevention and treatment strategies for HG require an understanding of both pathophysiological and psychosocial factors, awareness of potential risks and complications, and proactive assessment and treatment methods using innovative clinical tools. HG is characterized by dehydration, electrolyte and metabolic imbalance, as well as nutritional deficiency, which can lead to hospitalization. The severity of nausea and vomiting during pregnancy can be assessed using the Unique Gestational Vomiting Qualification (scale PUQE-24), which has been shown to be a relatively accurate assessment of the patient’s lifestyle, including hours of sleep. For high-quality differential diagnosis, a focused anamnesis collection and examination are necessary, since the diagnosis of this condition is mainly determined clinically. Laboratory tests are useful tools for evaluating complications such as electrolyte or metabolic imbalances or kidney damage. In addition, they help to determine the etiology in refractory cases. Hypotheses that contribute to the understanding of the pathogenesis of HG have been based on associations that are causal, sequential, or coincidental. Much efforts are needed to precisely establish these relationships in well-designed studies. HG is the most common indication for hospitalization in the first half of pregnancy. Numerous nutrient deficiencies have been identified, such as thiamine deficiency, which can lead to Wernicke’s encephalopathy, vitamin K deficiency, and severe hypokalemia. It is noteworthy that, in addition to the above-mentioned physical complications, HG is also associated with psychological adverse consequences. Although it has been associated with serious complications, little is known about its prognostic factors. The purpose of this systematic review was to find and critically evaluate studies that determined the priority areas of clinical management of vomiting in pregnant women, based on the differentiation and pathophysiological component, the analysis of the safety profile of non-pharmacological agents to prevent the development of the above-mentioned gestational pathology, and the clarification of an effective strategy of interprofessional teams to improve care coordination and outcomes in pregnant women with nausea and vomiting. A systematic data search was carried out in the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects and publications in professional publications of Ukraine for 2010–2023. The main result was the prediction of the occurrence of vomiting in pregnant women and HG, the effectiveness of preventive intervention, the reduction or cessation of nausea/vomiting; the number of episodes of vomiting; duration of hospitalization. Secondary outcomes included other parameters of preventive strategy effectiveness, adverse maternal/fetal/neonatal outcomes, quality of life measures, and economic costs. Preventive measures: ginger, acupressure/acupuncture, diet, hypnotherapy. The economic evaluation of prevention strategies also took into account perinatal outcomes. Therapeutic strategies, primarily infusion therapy, will be reviewed and analyzed by us in the following review. The results of evidence-based medicine presented in the reviews can be used in the creation of a clinical guideline, protocol, consensus or clinical recommendations regarding the clinical management of nausea, vomiting of pregnancy and HG. [ABSTRACT FROM AUTHOR]

Genital herpes is one of the most common sexually transmitted diseases. Most cases of genital herpes are diagnosed in persons from 16 to 40 years old, which correlates with more sexual contacts. Herpes simplex virus, type 2 (HSV-2), is the main virus that causes genital herpes, although the number of cases caused by HSV type 1 (HSV-1) has increased in the recent decades. The prevalence of HSV-2 exceeds 50%, and this number rises to almost 100% in risk groups. Taking into account the insufficient, and sometimes controversial, information about the epidemiology, diagnosis and treatment of genital herpes at the preconception stage and during pregnancy, the purpose of this review was to analyze the sources of evidence-based medicine in accordance with the understanding and solution of the problems of clinical management of genital HSV during pre-gravid This review analyzes the results of preclinical and clinical research on optimal diagnosis and rational therapy of herpes virus infection in the pre-gravid period and during pregnancy with the involvement of the most effective drugs. A systematic data search was performed using MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, and Proquest databases for 2010–2023. To confirm the diagnosis, it is advisable to verify HSV DNA, if possible, to determine its type by molecular biological methods (PCR) in the contents of vesicles, from the bottom of ulcers and in the biological fluids, organism secretions, taking into account the localization of the process; however, routine HSV screening is not recommended for all pregnant women. For the treatment of the primary clinical episode of anogenital herpes as an episodic therapy at the stage of pregnancy planning, oral acyclovir, or valacyclovir, or famciclovir is recommended. During pregnancy, the drugs of choice for the treatment of herpesvirus infection are acyclovir or valacyclovir. Local treatment is not recommended due to low efficiency. Genital HSV infection during pregnancy can lead to infection of the fetus or newborn. The risk of transmission to the newborn is higher if the infection of the seronegative mother occurs in the third trimester of pregnancy. Daily use of acyclovir should be considered from 36 weeks of pregnancy, in the absence of other obstetric indications for cesarean section, vaginal delivery should be planned. The women with primary genital herpes in the third trimester of pregnancy are at high risk of transmitting HSV to their newborns, so they should be counseled and offered caesarean section to reduce this risk. Famciclovir is included in the world protocols (USA, Canada, Europe, Australia) for the effective treatment of herpes infection due to its high bioavailability (77.0%) and the longest period of stay in the virus-infected cell (up to 20 hours) than other drugs for the treatment of HSV-2. [ABSTRACT FROM AUTHOR]

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