The purpose of the study was a detailed evaluation of the ultrasound features of the ovarian endometriomas (endometrioid cysts) in pre- and postmenopause.

Material and methods. 155 patients (150 premenopausal and 5 postmenopausal) with morphologically proven endometrioid cysts were examined. A total of 259 endometriomas in premenopause and 6 endometriomas in postmenopause were found in 155 patients. Lesions described in accordance with the recommendations of the IOTA group. Prospective risk stratification of endometrioma malignancy was performed using the O-RADS v2022 ultrasound classification. Statistical processing of the data was carried out using standard statistical methods.

Results. In more than 15% of cases of ovarian endometriosis in premenopause, two or more endometriomas can be found in the involved ovary, and in every third patient, both ovaries are involved in the process. The following ultrasound signs characterized the majority of endometriomas in premenopause: a unilocular lesion with smooth internal contours with "ground glass” internal contents ± dotted echogenic foci in the wall ± solid/papillary avascular component. In approximately every tenth premenopausal endometrioma, other types of internal contents may be determined rather than “ground glass” (anechoic, rare echogenic suspension, liquid-liquid level, mixed echogenicity). In most postmenopausal endometriomas, mixed echogenicity, solid components with vascularization, septations with vascularization, and an irregular internal contour are very common.

Conclusions: Most endometriomas in premenopausal women have typical signs that allow them to be confidently diagnosed by ultrasound. However, it can be exceedingly challenging to distinguish postmenopausal endometriomas from malignant lesions since they commonly lack the typical signs. Thus, an ultrasound conclusion of the presence of endometrioma in postmenopausal women is inappropriate.

The number of cesarean sections performed worldwide continues to rise each year. In Europe, cesarean deliveries account for approximately 25% of all births. Global concern about the increase in the number of operations is justified and is associated with an increase in the number of complications. An incompetent uterine scar poses significant risks for both maternal and fetal health in subsequent pregnancies. Currently, there is no “gold standard” for assessing the postoperative suture and subsequently the uterine scar, and the factors influencing its healing remain unclear. Additionally, the impact of emergency versus elective cesarean sections on scar integrity and clinical outcomes has not been completely determined.

The aim of the study was to evaluate the factors affecting postoperative suture healing following cesarean delivery during labor.

Materials and Methods: The study included 100 women with singleton pregnancies, categorized into four groups based on the degree of external cervical os dilation: 0–1 cm dilation (n = 43), 2–4 cm dilation (n = 20), >4 cm dilation (n = 24), control group – elective cesarean section (n = 13). All women underwent cesarean delivery in cephalic presentation at term, with no prior uterine scar. On the third postpartum day, all patients underwent transvaginal ultrasound to assess the postoperative suture. The evaluation included measurements of the distance between the suture and the internal and external cervical os, uterine position, suture length, width, and thickness, as well as the thickness of the adjacent myometrium above and below the suture. Additional parameters included cervical length, uterine length, width, anteroposterior uterine diameter, anteroposterior uterine cavity diameter, anterior uterine wall thickness, and posterior uterine wall thickness. 

Our study found that uterine suture thickness correlated with its distance from the internal and external cervical os: the greater the distance, the thinner the suture. Ultrasound features of the uterine suture were also influenced by uterine position, with significantly greater suture length and thickness observed in cases of uterine anteversion. Additionally, the presence of chronic diseases impacted suture healing; the thickness of the adjacent myometrium below the suture was significantly reduced in patients with arterial hypertension.

Thus, a comprehensive assessment of postoperative suture  parameters, anatomical features, and comorbid conditions may provide a more complete understanding of uterine suture healing and the likelihood of forming a competent scar.

The article presents a review of literature focusing on the measurement of the lower uterine segment in pregnant women with a uterine scar in order to predict the risk of uterine rupture. The results of the review demonstrated heterogeneity among studies and the absence of an agreed threshold for lower segment thickness, which makes predicting the risk of uterine rupture based on lower segment measurements in women with a uterine scar uncertain and unreasonable.

Introduction. Mirror syndrome, also known as Ballantyne's syndrome or triple edema syndrome, is a rare complication of pregnancy that clinically manifests with generalized edema in the pregnant woman, and placental hypertrophy and fetal anasarca in ultrasound. At the middle of pregnancy, the woman begins to suffer from sudden weight gain, delusional anemia, hypoprotein/albuminemia, thrombocytopenia, severe edema, serous cavity effusions, and respiratory disorders, all combined with significant arterial hypertension and proteinuria, leading to a clinical picture resembling extremely early onset of severe preeclampsia, which often necessitates urgent termination of pregnancy with a very poor perinatal prognosis. With timely delivery, the symptoms of Ballantyne’s syndrome in the mother resolve spontaneously within three to seven days, further linking its clinical presentation to severe preeclampsia.

 Case report. We present a case of Ballantyne syndrome in a patient with a monochorionic diamniotic twin pregnancy following fetoscopic laser coagulation of placental anastomoses due to stage III twin-to-twin transfusion syndrome. The syndrome manifested with total subcutaneous edema, ascites, and pericardial effusion. The maternal clinical presentation included progressive generalized subcutaneous tissue edema, interstitial pulmonary edema, and persistent arterial hypertension. Due to the lack of clinical improvement despite intensive therapy, a joint decision with the patient was made to terminate the pregnancy, after which all clinical symptoms rapidly regressed. 

Conclusion. Ballantyne’s syndrome represents a life-threatening complication for both the mother and fetus during pregnancy, requiring further study to develop effective methods of prevention and management.

Objective. To evaluate the effectiveness of using the right parasternal view (RPV) in addition to the apical five-chamber view (A5CV) for assessing the severity of aortic stenosis (AS) and to identify factors influencing the concordance of AS severity assessment between RPV and A5CV.

Materials and Methods. During the patient recruitment period, 232 patients were consecutively examined, and 186 (80%) patients with an available RPV were included in the final analysis.

Inclusion criteria: Patients with AS (combination of a calcified aortic valve and a peak transaortic velocity >2.5 m/s) and an available RPV for AS severity assessment.

Results. The average Gmax and Gmean values assessed in RPV were significantly higher, and the average AVA and DVI values were lower compared to similar values assessed in the A5СV, p <0.05. Bland-Altman analysis showed that the mean differences in Gmax and Gmean between A5CV and RPV were 10.2±14.3 mmHg and 4.5±8.9 mmHg, respectively. The mean differences in AVA and DVI between A5CV and RPV were 0.1±0.15 cm² and 0.02±0.03 ml, respectively. Using RPV allowed reclassification of AS severity to a more severe degree of aortic stenosis in 44 (23%) patients. Multivariate logistic regression analysis identified the aorto-septal angle as the only independent parameter significantly affecting the concordance of AS severity assessment between the two acoustic projections (OR 0.76; 95% CI 0.69-0.83, p <0.001).

Conclusion. 1. The use of A5CV alone may lead to an underestimation of AS severity in a significant proportion of cases. Assessing the severity of aortic stenosis in the RPV in addition to the A5СV can significantly increase the diagnostic accuracy of echocardiography.

2.The aorto-septal angle is an independent factor significantly influencing the concordance of AS severity assessment between the two echocardiographic views.

The article presents a clinical case of a 49-year-old man with a long history of alcohol abuse, type 2 diabetes mellitus and hypertension, who was hospitalized with symptoms of acute heart failure. Coronary angioventriculography excluded significant atherosclerotic lesions of the coronary arteries, revealed apical ballooning of the left ventricle (LV), and suspected takotsubo syndrome (TS). Subsequent examination revealed hyperglycemia, increased troponin I levels, decreased global contractility of the LV myocardium, and signs of obstructive hypertrophic cardiomyopathy (HCM). During inpatient treatment, including infusion therapy, beta-blockers and glucose monitoring, the patient's condition improved. Subsequent studies conducted at the outpatient stage confirmed the presence of HCM with a dynamic decrease in the degree of LV outflow tract obstruction, indicating a complex interaction between ST, HCM and withdrawal syndrome against the background of alcohol dependence. This case emphasizes the importance of differential diagnosis and an integrated approach to the treatment of patients with multiple comorbidities.