Relevance. According to research data, up to 8.2% of women enter gestation with pre-existing arterial hypertension (AH), and one third of women have hypertension for the first time before 20 weeks of pregnancy.
The purpose of the study. To study the expression level of microRNA-181a in blood plasma in the first trimester of pregnancy in patients with chronic arterial hypertension (CAH) without preeclampsia, women with CAH-associated preeclampsia (NPE) and pregnant women without a history of hypertension with normotensive pregnancy.
Materials and methods. The study included 130 patients: group 1 (n=58) consisted of pregnant women with CAH without preeclampsia, group 2 (n=42) included women with NPE, and group 3 (n=30) included healthy pregnant women. The expression level of microRNA-181a in blood plasma was assessed in the studied groups at 12-14 weeks gestation using quantitative polymerase chain reaction in real time. Statistical data processing was performed using the IBM SPSS Statistics licensed software package (version 26.0, USA).
Results. Multidirectional changes in the expression level of microRNA-181a were revealed in the study groups: a significant decrease in the expression level of microRNA-181a in the group of patients with NPE compared to women with isolated CAH (p1-2 <0.001) and with healthy pregnant women (p2-3=0.004) and an increased expression level in patients with CAH without PE compared to with the NPE group (p1-2<0.001) and normotensive pregnant women (p1-3=0.011).
Conclusion. microRNA-181a in the first trimester of pregnancy has the potential of aprognostic noninvasive marker of the development of NPE. Further research is required to study the possible mechanisms of the effect of microRNA-181a on the pathogenesis of NPE.

Introduction. The literature review presents modern views on childbirth in patients with a uterine scar from a cesarean section. Thus, in Russia, the frequency of cesarean sections averages 15-16%, reaching 30-40% in perinatal centers.
Objective. To summarize the literature on optimizing childbirth in patients with a uterine scar.
Materials and methods. The review includes published data for the past 10 years. The literature search was conducted in the Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley and Cochrane Library databases.
Results. The most common indications for planned cesarean section are: the presence of a uterine scar, breech presentation of the fetus, anatomically narrow pelvis, intrauterine fetal hypoxia, etc. A possible way to reduce the incidence of cesarean sections is to increase the frequency of spontaneous labor in patients with a uterine scar.
Conclusion. An analysis of literature data has shown that the experience accumulated over the past years substantiates the possibility of performing a certain contingent of women with a uterine scar, safe for both the mother and the fetus. Thus, the uncontrolled growth in the number of women with a uterine scar after CS, the versatility and ambiguity of the solution to the main issues of this problem dictate the need to continue research in this area.

Pathological blood loss complicates the course of labor and postpartum periods even in patients with an initially low risk of these complications.
The purpose of the study. To provide an overview of foreign and domestic scientific literature on the causes of bleeding during childbirth and the postpartum period in low-risk patients.
Materials and methods. The search was carried out in literary databases: Medline, Pubmed, Web of Science, Elibrary.
Results. It has been revealed that currently the polymorphism of thrombophilia and vascular-endothelial growth factors genes plays a major role in the formation of endothelial dysfunction, which is given special attention when discussing the genesis of bleeding during childbirth and the postpartum period in patients at high risk of developing pathological blood loss. However, there is no evidence of the effect of these mechanisms on the formation of pathological blood loss in the postpartum period and in childbirth in low-risk patients. The prospects for research in this field are characterized by the potential to identify new risk factors, uncover pathogenesis links, and predict postpartum bleeding.

Background. Multiple pregnancies significantly increase the risk of a number of complications, including maternal (preeclampsia, gestational diabetes mellitus, anemia, postpartum bleeding) and fetal (fetal growth retardation, feto-fetal transfusion syndrome, congenital malformations). The maternal and perinatal mortality rate is significantly higher than that of single pregnancies. The fact that in most cases the outcome of multiple pregnancies is early preterm surgical delivery plays a significant role. There is currently a lack of aggregated data on higher order multiple pregnancies due to heterogeneity in the sampling and different design of studies. At the same time, there has been a significant increase in the incidence of such cases over the past 40 years, given the development of reproductive assistive technologies, which requires the identification of optimal pregnancy and delivery tactics, as well as the postpartum period in patients with multiple pregnancies of higher order.
Objective. Systematization of modern scientific data about perinatal complications associated with multiple pregnancies of higher order.
Material and methods. Analysis of current literature data presented in the databases MEDLINE, ELibrary, Scopus, Web of Science, Google Scholar, for the period from 2019 to 2025. Additional resources from the literature lists of submitted articles were used.
Research results. Up to 66.7% of multiple pregnancies of higher order are complemented by a series of serious obstetric complications. On the mother’s side to such complications are attributed: great obstetrical syndrome (hypertensive disorders and preeclampsia — 46.3%, gestational diabetes mellitus — 28%, premature labor — 97.9%), anemia of pregnant women — 71.4%, operative abdominal delivery, postnatal bleeding — 33,3% and postpartum depression — 23%). The main complications of the side of the fetus are: selective growth retardation, congenital developmental defects, intrauterine death of the fetus, feto-fetal transfusion syndrome, twin reversed arterial perfusion sequence and twin anemia polycythemia sequence (in monochorea type of multiple pregnancy). In the neonatal period, there are complications such as: respiratory disorders (54.4%), extremely low birth weight (30.8%), intra-ventricular hemorrhage (38.5%), infection (25.5%), neonatal jaundice (11.4%) and transitory tachypnoea (5.2%). In the later period of development such children have a high risk of disability (50%), CDD (15-20%) and cognitive impairment.
Conclusion. The problem of multiple pregnancies of higher order, associated with a high risk of maternal and perinatal morbidity and mortality, is now highly topical and requires optimization and personalization of approaches to obstetric care, the timing and delivery methods of such a pregnancy.

Introduction. There are many works in the literature devoted to the study of the features of the course of gestational diabetes mellitus (GDM) in patients with placental insufficiency (PI) separately. However, with a combination of the above complications of pregnancy, there are very few studies, therefore, the problem requires detailed study.
Objective. To determine the characteristics of the course of pregnancy complicated by PN and GDM on diet therapy.
Materials and methods. A longitudinal cohort comparative study was conducted. The study included 120 patients in the II-III trimester of pregnancy with GDM on diet therapy. The main group consisted of 70 women whose pregnancy was complicated by sub- and decompensated forms of PI. The comparison group included 50 pregnant women without pathology of the fetoplacental complex. All patients underwent anthropometry, biochemical blood tests, with determination of the level of total protein, albumin, urea, creatinine, glucose, ALT, AST in the blood, total cholesterol, triglycerides, high, low, very low density lipoproteins, atherogenic index in the mother’s blood. Comparison of continuous quantitative data was performed using the Mann-Whitney test, which was calculated using the MedCalc 15.8 application program. The null hypothesis was rejected at p<0.05.
Result. When assessing the state of carbohydrate metabolism in patients of the study group, it was found that GDM was compensated by diet therapy. The analysis of protein, carbohydrate and lipid metabolism indices, as well as the activity of key metabolic enzymes — AST and ALT — in pregnant women with PI and GDM on diet therapy showed that patients in the main group had significantly higher levels of creatinine, De Ritis coefficient and glycated hemoglobin, as well as a decrease in transaminases, cholesterol, relative to the comparison group.
Conclusion. Our study demonstrated that in the metabolism of women with PN and GDM compensated by diet therapy, catabolic processes predominate, which may be an important pathogenetic unit.

Monochorionic multiple pregnancy complicated by transfusion syndrome (MCTP) is associated with higher maternal serum levels of both hCG and thyroid hormones. There are virtually no data on the clinical consequences of MCTP for the mother and fetus in this situation.
Case report. A 32-year-old multiparous patient with monochorionic diamniotic twins with stage III MCTP was admitted to the Research Institute of Obstetrics and Maternity Care at 21-22 weeks of pregnancy with complaints of weakness, dyspnea at rest, tachycardia up to 180 bpm. There were no indications of thyroid disease. Antibodies against thyroid peroxidase and TSH receptors were not detected. TSH level 0.007, CT3 128 pmol/l, CT4 162 pmol/l. Thyroid ultrasound was unremarkable. To reduce the heart rate, beta-blocker therapy was started. Selective laser coagulation of placental anastomoses was performed in the volume of 19 AV, 4 AA, 2VV. Amnioreduction was 2500 ml. A 2-fold decrease in the hCG level was noted after 2 weeks, and after another 2 weeks, the hCG levels reached normal values for the period in multiple pregnancies. Within 2 weeks after the operation, the patient’s pulse normalized, shortness of breath and weakness decreased.
Сonclusion. This clinical case demonstrated a change in the mother’s thyroid function in TTTS before and after laser therapy. In the differential diagnosis of causes of thyrotoxicosis in pregnant women, endocrinologists and obstetricians should consider hCG-mediated hyperthyroidism associated with TTTS, since this condition is not expected to resolve spontaneously until fetoscopic laser coagulation of placental anastomoses is performed.

Introduction. Premature placental abruption (PPA) is the leading cause of obstetric bleeding with pathological and massive blood loss, critical obstetric conditions in women, fetal death, and newborn disability.
The aim of the study. To study the features of placental morphology in patients with complicated pregnancy and childbirth with PPA.
Research material and methods. A prospective study was conducted in the period 2021- 2024. The results of a clinical and laboratory examination of 84 pregnant women, as well as the characteristics of their labor and the morphological examination of their placentas, were analyzed. The main group consisted of patients whose labor was complicated by PPROM, n=42, while the comparison group included women without PPROM complications, n=42. A descriptive method was used to assess the qualitative characteristics of the placentas. The morphological examination of the placentas was conducted using electron microscopy.
Results. The article provides a comparative analysis of the macroscopic and ultra-morphological structure of the placenta in cases of PPROM and without it. The characteristic feature of the placenta structure in cases of PPROM is the presence of destruction of the syncytiotrophoblast cell architecture, which leads to acute placental insufficiency. This, along with bleeding, is an indication for emergency abdominal delivery in the interests of both the mother and the fetus.