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The results of recent studies show that tumor biology, coagulation activation, and inflammatory reactions profoundly contribute to the thrombosis pathogenesis in cancer as well as tumor progression, metastasis, and developing chemoresistance. Cancer is an independent predictor of thrombosis. During carcinogenesis, tumor cells express proinflammatory cytokines, proangiogenic and procoagulant factors, and also stimulate other cells to express various components promoting emerging thromboinflammation. The discovery of neutrophil extracellular traps (NETs) provides an opportunity to take a new look at biology and a role neutrophils may play in thromboinflammation and tumorigenesis. The close interplay between tumor cells, tumor-associated neutrophils and NETs as well as other players in the tumor microenvironment underlies activation of thromboinflammation in cancer patients not only resulting in thrombus formation, but also promoting tumor growth and dissemination.

Hypercoagulation is a typical condition for cancer patients. In addition, various arms of the hemostasis system become involved in tumor growth, invasion, metastasis, neoangiogenesis as well as immunoevasion. The magnitude of activated hemostasis is driven by tumor phenotype. Parameters characterizing coagulation, intensity of fibrinolysis processes, platelet aggregation and activation as well as endothelial activation mirror magnitude of hemostasis activation in oncological process, but may also be considered as candidate markers of tumor progression and predictors of oncological diseases outcome. This review summarizes the study data assessing a value of predictive hemostasis biomarkers for overall survival and response to therapy in oncogynecology and mammology. The most promising biomarkers have been identified and used in the future for risk stratification as well as personalized patient management.

Studies of the pathogenesis of thrombosis and inflammation and their contribution to tumor progression and metastasis in cancer patients, initiated many decades ago, have been continued to this day. At the same time, thrombosis and inflammation are inextricably linked to each other. One of the central places in thromboinflammation is held by the loss of normal antithrombotic and anti-inflammatory function in endothelial cells, which leads to dysregulated coagulation, imbalanced the complement system, platelet activation and recruitment of leukocytes in the microvasculature. In turn, tumor cells affect the hemostasis by releasing procoagulant substances, activating fibrinolysis, proteolysis, increasing platelet activation and aggregation, releasing adhesion molecules, secreting pro-inflammatory and pro-angiogenic cytokines. Future research aims to advance an understanding of thromboinflammation in oncology, particularly focusing on the role of platelets beyond hemostasis and thrombosis, as well as some new players in the process. In the future, the main attention will be paid to investigating molecular mechanisms that regulate cancer-related thromboinflammation, providing insights into mechanisms underlying both inflammation and thrombosis as pathogenetic components in cancer patients. Altogether, it will provide an opportunity to create new, modern strategies to treat cancer patients.

Introduction. External genital endometriosis (EGE) is a chronic, relapsing disease that affects various aspects of sexual function, the quality of sexual and interpersonal relationships, physical and psycho-emotional health and leads to social maladjustment and anxiety-depressive disorders, resulting in progressively decreased quality of life (QoL).Aim: to analyze an impact of sexual disorders on QoL of women with painful and painless EGEs.Materials and Methods. A prospective comparative randomized interventional study involved 160 patients (110 and 50 women with painful and painless EGE, respectively) of reproductive age, with laparoscopically and morphologically verified diagnosis according to the revised American Fertility Society scoring system (R-AFS, 1996). Pain syndrome and sexual dysfunction were assessed using specialized questionnaires: visual analogue scale (VAS), PainDETECT, and Female Sexual Function Index (FSFI). After surgical treatment, 8 patients refused to participate in the study (6 with painful EGE and 2 with painless EGE). Thus, only 152 women passed all stages of the study. The patients were divided into 4 groups depending on the presence and/or absence of pain syndrome and the tactics of the rehabilitation period ("active" or "passive"): group IA consisted of 49 (47.1 %) women with pain and "active" rehabilitation; group IБ – 55 (52.9 %) women with pain syndrome and "passive" rehabilitation tactics; group IIA – 23 (47.9 %) patients without pain syndrome with "active" rehabilitation; group IIБ – 25 (52.1 %) patients without pain syndrome with "passive" rehabilitation tactics.Results. Women with painful vs. painless EGE were found to have a more severe course of the disease and a markedly decreased quality of sexual life. It was observed that patients with "active" rehabilitation tactics (groups IA and IIA) had intensity of the pain syndrome and the neuropathic pain component significantly decreased, improved parameters of the quality of sexual life, sexual desire and sexual excitability compared to patients with "passive" rehabilitation tactics applied with the measures within the framework of the National Clinical Guidelines (groups IБ and IIБ).Conclusion. A significantly decreased quality of sexual life of EGE patients indicates a need for assessing and correcting sexual disorders as well as introducing early onset of rehabilitation measures by using a multidisciplinary approach.

Introduction. Autoimmune thyroiditis (AIT) is the most prevalent among the autoimmune pathologies and multifactorial thyroid diseases; accordingly, remaining a pressing issue for investigation.Aim: to study AIT profile in different age groups of the female population in the western region of Georgia – Adzhariya.Materials and Methods. A prospective comparative study in parallel groups was carried out. There were examined 405 samples of venous blood obtained at «Health» Clinic from women of two groups: group 1 – 159 patients with AIT, group 2 (control) – 246 women without AIT. Blood samples were collected between the years 2017 and 2020. There were analyzed serum antibodies against thyroperoxidase (TPOAb), thyroid stimulating hormone (TSH) as well as level of free thyroxine (FT4) by using enzyme immunoassay.Results. Patients with AIT from different age groups vs. control group were found to have decreased level of FT4, but increased amount of TSH and TPOAb. At the reproductive age (18–45 years), a significant increase in the level of TSH was found (6.12 times) compared with the control group (p < 0.0001). The level of FT4 and TSH in AIT women aged 51 to 60 years was 0.7880 ± 0.3584 ng/ml and 4.754 ± 2.433 U/ml that significantly differed from those in the control group – 1.314 ± 0.4044 ng/ml (p < 0.0001) and 2.276 ± 1.409 U/ml (p < 0.0001), respectively.Conclusion. AIT occurs in women of all age groups, but is more common in women aged 51 to 60 years. In a number of cases, TPOAb was detected in the control group, which, apparently, is associated with increased intake of dietary iodized salt since 2005 in Georgia (the adoption of the law on universal salt iodization). A significant increase in the level of TSH, in AIT women aged 18–45 years, strongly suggests to perform diagnostics of and screening for AIT not only in females of menopausal period, but also in reproductive age.

An issue of habitual miscarriage poses a high social importance especially during COVID-19 pandemic. Meanwhile, healthcareworkers faced a mass media campaign against using micronized progesterone upon habitual miscarriage, which, as viewed by us, displays signs of prejudiced data manipulation and may disorient practitioners. In this Letter we provide objective information on accumulated data regarding gestagenes efficacy and safety. We invoke healthcare professionals to make decisions deserving independent primary source trust presented by original scientific papers published in peer-reviewed journals, clinical recommendations proposed by professional medical communities as well as treatment standards and protocols.

The problem of sepsis and septic shock has recently become more and more actual. In obstetrics and gynaecology, the number of cases of sepsis has more than doubled over the past 10 years. The review examines the clinical forms of septic conditions, risk factors, pathogenesis of sepsis and septic shock, the main pathogens of septic conditions. Special attention is paid to neonatal sepsis. The relationship between septic shock and viral infections is considered in the context of the novel coronavirus infection caused by SARS-CoV-2 (COVID-19) pandemic. Hemostasis abnormalities have been demonstrated in patients with septic shock, including disseminated intravascular coagulation (DIC). The importance of determining the level of ADAMTS-13 to refine the forecast is discussed.

Aim: to demonstrate the role and importance of prenatal diagnosis of abnormally invasive placenta.Materials and methods. Retrospective analysis of 3 clinical cases of the delivery in Health Center Medina. All women were diagnosed with the complete placenta praevia and invasion of chorion in the myometrium, the last was confirmed by the results of histological examination. Anamnesis data, extragenital pathology and results of examination during pregnancy were analyzed. In the prenatal period the diagnosis was confirmed by the results of ultrasound examination and MRI in two women.Results. All women were diagnosed with the different degree of placenta praevia, 2 women had a cesarean section in the past history. All patients had unifetal pregnancy without complications and no extragenital pathology was noted. 2 women were diagnosed with the placenta praevia using ultrasound scan and MRI, were estimated the degree and topography of placental invasion. Both women had planned caesarean section. During operation was performed autohemotransfusion using a Cell Saver system. In one of the cases urgent c-section was performed due to the massive bleeding, presence of placental invasion was diagnosed intraoperatively. Hysterectomy was performed in all 3 cases, total blood loss was 950–1450 ml in patients with the prenatally diagnosed invasive placentation. Iliac artery ligation was performed to the third patient, due to excessive bleeding and development of coagulopathy, 1200 ml of fresh frozen plasma has been transfused for correction of coagulopathy, as well as transfusion of donor erythrocyte mass.Conclusion. Probably the development of placental invasion abnormalities along with other factors is mostly affected by presence of placenta previa and cesarean section in the patient’s past history. Prenatal assessment of presence and degree of the abnormal placental invasion is important factor for planning of delivery: gestational age, method and the hospital level.