Postpartum hemorrhage (PPH) represents a critical emergency condition and the principal cause of maternal morbidity and mortality worldwide. It encompasses excessive bleeding following childbirth, which can arise from various causes. Prompt recognition and management are essential to mitigate severe outcomes and ensure maternal safety. The incidence of PPH in low- and middle-income countries (LMICs) is higher than in developed countries. Healthcare systems in developing countries face multiple challenges that may impact PPH management at policy, facility, and community levels. The mentioned barriers could be addressed by providing an empowering environment via the implementation of supportive policies, access to PPH care, planning supplies, allying strategies, providing training, and utilization of guidelines and algorithms for PPH management. Evidence-based international guidelines should serve as an integral part of appropriate management. On the other hand, LMICs have limited opportunities to implement the proposed international algorithms and guidelines. Therefore, some amendments based on the resource/expertise availability should be considered at the specific clinical site. This review summarizes and updates the accumulated knowledge on postpartum hemorrhage, focusing on challenging management options in developing countries. In many LMICs, maternal morbidity and mortality linked to PPH were improved after the implementation of standardized protocols and timely and purposeful interventions. International support in healthcare professionals’ training, enhancing resources, and the provision of an adapted evidence-based approach could assist in improving the management of PPH in LMICs. Refining our understanding of specific local circumstances, international support in specialists’ training, and the provision of evidence-based approaches may assist in improving the management of PPH in LMICs and contribute to safer childbirth.

Cervical cancer is a largely preventable malignancy of the uterine cervix. The tendencies in cervical cancer morbidity and mortality have remained similar for the past decade, albeit with increasing frequency in low- and middle-income countries (LMICs). Moreover, in the majority of LMICs, cervical cancer is the second most prevalent cancer and the second most common cause of cancer-related death among reproductive-age women. High-risk human papillomavirus (HR-HPV) infections have been proven to be associated with up to 95% of cervical cancer cases, with HPV-16 and HPV-18 types being responsible for approximately 70% of all cervical cancers, with the other high-risk HPV types accounting for up to a further 25%. More recently, the latest data appear to confirm there is a change in the frequency of HR-HPV occurrence, especially HPV-16 and HPV-18, as a reflection of the implementation of preventive vaccination programs. Owing to the growing incidence of cervical cancer among reproductive-age women and with the development of cancer management approaches, fertility-sparing options have been proposed for early-stage cervical cancer management as an option for young women, especially those with unaccomplished reproductive desires. However, methods applied for this purpose (cold-knife conization, loop electrosurgical excision, trachelectomy) have variable outcomes and do not prevent risks of relapse. Multiple factors are involved in cervical cancer recurrence, even in cases treated at the early stage of the disease. In this review, the authors unveil whether HPV infection and virus type could be one of the key factors associated with cervical cancer recurrence after fertility-sparing surgery. Reviews of the literature reveal that recurrent and persistent HR-HPV infection is a strong predictor of cervical lesions’ relapse. In particular, HPV-16 and HPV-18 infections and their persistence have been reported to be associated with cervical cancer recurrence. HR-HPV genotyping before and after fertility-sparing surgery for cervical cancer could facilitate a personalized approach and improve the overall survival rate. Screening for HR-HPV is essential during the follow-up of cervical cancer-treated women and will help to predict possible cancer recurrence.

Cervical cancer remains the fourth most common malignancy among women worldwide. Despite well-developed prevention measures, incidence and mortality continue to rise, especially in low- and middle-income countries due to low screening coverage and unavailability of human papillomavirus (HPV) vaccination. The cervical cancer screening coverage could be improved by the implementation of a self-sampling modality for HPV testing. Multiple research pieces support the validity and reliability of a self-sampling modality as an alternative approach to clinician-collected samples for primary cervical cancer screening via HPV genotyping. Moreover, growing research evidence on the self-sampling modality reception shows high acceptance of the method among screened populations. Studies on the self-sampling approach economic efficiency also revealed a high cost-effectiveness of HPV testing through a self-sampling modality compared to other screening modalities for cervical cancer. It is specifically important for low-resource settings, which should use the self-sampling cost advantages to improve cervical cancer screening coverage by attracting underscreened populations. Overall, self-sampling modality has a higher participation rate and better patient satisfaction reported; thus, the method is highly recommended by the World Health Organization for cervical cancer screening.

Relevance: Linked to the hypothalamic-pituitary-adrenal axis, changes in reproductive hormones interact to control the menstrual cycle via regulating cortisol. Ongoing research has not fully clarified the dynamic interaction between menstrual phases and cortisol release in healthy women. The study aimed to evaluate and combine the present information on phase-specific cortisol changes during the menstrual cycle and their influence on emotional and reproductive health. Materials and Methods: Papers published between 2014 and 2024 were thoroughly searched using PubMed, Scopus, and Web of Science. Published in Q1-Q2 journals, qualifying studies described cortisol levels in healthy women during menstrual cycles. A narrative synthesis approach was inspired by methodological variety. Results: The cortisol levels were higher in the follicular and ovulatory stages and lower in the luteal phase. Premenstrual syndrome was linked to changes in the cortisol awakening response and increased symptomatology. Hormonal birth controls reduced stress reactivity and balanced cortisol cycles. Researchers linked failed ovulation and poor fertility to increased cortisol. Changes in the neuroendocrine system could also bring about emotional symptoms throughout the cycle. Conclusion: Cortisol secretion varies with the menstrual period and may influence mood, stress reactions, and reproductive function. These findings influence how to manage disorders connected to menstruation and optimize women’s health. More studies employing standardized methods are needed to confirm clinical relevance.

SOCIO-PSYCHOLOGICAL ADAPTATION CAPABILITIES OF FOREIGN STUDENTS

Topicality: Abortion is an artificial termination of pregnancy that causes a serious change in the hormonal background. One of the modern most sparing methods of termination of pregnancy is considered to be medical termination of pregnancy in the early stages through the use of biologically active substances. After the termination of pregnancy, the body, which has begun preparing for carrying a child and lactation, is experiencing serious stress. No matter how gentle the method of termination of pregnancy is, it is still a serious psychological and physical trauma, hormonal stress and always presents a risk of serious complications. According to foreign and domestic scientific research, there is not enough research on the state of the pituitary gland and ovaries after a medical abortion, which was the purpose of our study. The purpose of the study: to study the hormonal status of women after medical abortion Research methods and materials. We observed 50 women who had no contraindications to pharmacological abortion in the post-abortion period after a medical abortion performed in an outpatient clinic with a delay in menstruation up to 63 days. All pregnant women were examined before medical abortion according to the clinical protocol of the MZRK Results. The age of women who applied to the clinic for abortion was on average 26-30 years (38%). There were no contraindications for medical abortion among pregnant women. According to pregnancy parity, every second pregnant woman was multiparous, every third was multiparous, and every fifth was primiparous. According to the results of a clinical examination, the hemoglobin values were not lower than 100 g/l in 90%, only in 10% hemoglobin was within 95 g/l. According to the results of a smear for the degree of purity of the vagina, every second woman had a second degree of purity of the vagina, which is considered within the normal range. The third degree of purity of the vagina was found in 34% of pregnant women, and the fourth - in 16%. Observation of women during medical abortion showed no complaints. According to the results of the third visit, it was found that among 74% of women among early post-abortion complications in 2 (6%) pregnant women, ultrasound revealed a hematometer, which subsequently led to late complications - menstrual irregularities against the background of chronic endometritis. Before and after medical abortion, all women were determined hormonal status by ELISA. For 3 months, the patients kept a menstrual calendar, as well as ultrasound of the pelvic organs at the end of medical abortion and subsequently on the 5th day of the menstrual cycle to study the state of the endometrium and ovaries. The novelty of the study: the study of the hormonal status of women will allow for the prevention of early ovarian failure among women at risk. Practical application of the study: use of combined oral contraceptives after medical abortion for 3 months. Актуальность: Аборт – искусственное прерывание беременности, вызывающее серьезное изменение гормонального фона. Одним из современных наиболее щадящих методов прерывания беременности считается медикаментозное прерывание беременности на ранних сроках путем применения биологически активных веществ. Послепрерывания беременностиорганизм, начавший подготовку к вынашиванию ребенка и лактации, испытывает серьезный стресс.Каким бы щадящим не был способ прерывания беременности, он все равно является серьезной психологической и физической травмой, гормональным стрессом и всегда представляет собой риск серьезных осложнений. По данным зарубежных и отечественных научных исследований недостаточно исследований по состоянию гипофиза и яичников после медикаментозного аборта, что и явилось целью нашего исследования. Цель исследования: изучить гормональный статус женщин после медикаментозного аборта. Методы и материалы исследования. Нами проведено наблюдение 50 женщин, не имевших противопоказаний к фармакологическому аборту, в постабортном периоде после медикаментозного аборта, проведенного в условиях амбулатории при задержке менструации до 63 дней. Все беременныепроходили обследование перед медикаментозным абортом согласно клиническому протоколу МЗРК. Результаты. Возраст женщин, обратившихся в клинику для прерывания беременности составил в среднем 26-30лет (38%). Среди беременных противопоказаний к медикаментозному аборту не было.По паритету беременности каждая вторая беременная была повторнобеременной, каждая третья-многорожавшей и каждая пятая – первобеременной. По результатам клинического обследования значения...