General Gynecology · Infections
Abstract
Aim
To provide an overview of complications and adverse outcomes related to induced abortion in female from the Eastern and Southern Ukrainian-Russian military conflict regions.
Materials and Methods
This are a multicentre combined retrospective and prospective cohort study. All women who underwent induced abortion in Eastern and Southern Ukrainian-Russian military conflict regions between 2022 and 2024 are included in the study.
Results
A total of 14,196 induced abortion were performed, 10,630 (74.9%) complications cases were observed. The most complication were infections (71.1%), cervical injury (6.6%), incomplete abortion (5.4%), hemorrhage (5.2%), and uterine perforation (4.9%). The most common infection related to induced abortions was endometritis (21.6%), cervicitis (17.8%), vaginal cuff infections (16.3%), peritonitis (12.3%) and pelvic abscess (10.7%), followed by adnexa utery (8.1%), parametritis (6.7%), salpingitis (5.1%), sepsis (1.3%) and other (0.2%) infections. The main risk factors was increased maternal age, surgical abortion approach, increased gestational age, prior cesarean delivery, presence of a bleeding disorder, fetal demise before the abortion, lack of healthcare facilities, lack of essential medication, lack of personnel and equipment, and surgical inexperience.
Conclusions
This study findings demonstrate the high rate of complications related to induced abortion in the Ukrainian-Russian military conflict regions. The ongoing war has led to a decline in the quality of healthcare services and main reason for the high rate of complications and adverse outcomes related to induced abortion in female from the military conflict regions.
Topics
By this author
Infections · Vaginal and Cervical Infections
Urinary tract infections in pregnant women from the Russian--Ukrainian military conflict regions: A multicenter study (2022-2025)
Salmanov AG et al., 2026 · Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
To estimates of the prevalence rate of urinary tract infections (UTIs) in pregnant women from the Ukrainian-Russian military conflict regions and antimicrobial resistance of causing pathogens. Materials and Retrospective multicenter cohort study was conducted from April, 2022 to May, 2025.The study population consisted of 2,576 pregnant women from the Ukrainian-Russian military conflict regions. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST guidelines. Among 2,576 pregnant women, 1,002 (38.9%) UTIs were observed. The most frequently reported UTI types were cystitis (48.4%) and asymptomatic bacteriuria (39%). Of all UTI cases, 14.6% were defined as acute pyelonephritis. The most common causative agents of UTIs were Escherichia coli (27.6%), Klebsiella pneumoniae (13.9%), Proteus mirabilis (11.2%), Coagulase-negative staphylococci (8.7%), Enterococcus faecalis (8.5%), Enterobacter spp. (7.2%), and Pseudomonas aeruginosa (6.6%). Methicillin-resistance S. aureus (MRSA), vancomycin resistance enterococci (VRE), and extended spectrum beta-lactamases (ESBL) production among Enterobacteriales was found observed in 11.3%, 9.1%, and 29.4% isolates, respectively. Carbapenem resistance was identified in 13.7% of P. aeruginosa strains. This study findings demonstrate the high rate of UTIs in pregnant women from the Ukrainian-Russian military conflict regions and many cases are caused by pathogens that are resistant to antibiotics. Strategies for deterrence include optimal hygiene practices to minimize the risk of bacterial colonization and ascending infection.
Pathophysiology · Origin Theories
Obstetric and gynecological surgical procedures, and surgical site infections as risk for the development of endometriosis: a multicenter study
Salmanov AG et al., 2025 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
Aim this study was to evaluate the incidence of endometriosis in women with a recent history of surgical site infections (SSIs), and obstetric and gynecological surgical procedures. Materials and A retrospective multicenter cohort was conducted on patients who have had obstetric or gynecological surgical procedures performer from January 2022 to December 2024 in 16 hospitals from six Ukrainian regions. Definitions of SSIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. The criteria for endometriosis were adapted from the ESHRE endometriosis guideline. The study included 33,126 reproductive women with endometriosis who had 16,724 obstetric and 32,383 gynecologic surgical procedures. The incidence of endometriosis in women with history of obstetric and gynecologic surgical procedures, and SSIs was 25.5% [95% confidence interval (CI), 24.3-26.4], 33.3% (95% CI, 33.0-33.6), and 22,1% (20.8-24.2), respectively. Multivariate analysis identified SSIs, obstetric and gynecological surgical procedures as three factors positively associated with the risk of endometriosis. Factors that increased the odds of endometriosis was SSIs (adjusted odds ratio [AOR], 3.76; 95% CI, 2.29-6.20), and obstetric and gynecological surgical procedures (AOR, 7.91; 95% CI, 3.68-37.3). An SSIs and obstetric and gynecological surgery history increased the odds of an endometriosis >7-fold in the cohort (AOR, 7.96; 95% CI, 3.64-37.2). Obstetric and gynecological surgical injury, and the inflammation resulting from SSIs may play a role in developing endometriosis.
Diagnosis · Staging and Classification
Epidemiology of endometriosis in female evacuated from the Eastern Ukrainian military conflict regions: results a multicenter study (2022-2024)
Salmanov AG et al., 2025 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
To estimate the prevalence and risk factors associated with endometriosis in female evacuated from the Eastern Ukrainian military conflict regions. Materials and A prospective multicenter cohort study was based on surveillance data for endometriosis. 982 women undergoing pelvic surgery were compared to 264 patients unexposed to surgery. The study cohort included women, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy in 2022-2024. Endometriosis among women was diagnosed visually at laparoscopy/laparotomy or by pelvic magnetic resonance imaging. The prospective multicenter study included 1,246 women. The overall prevalence of endometriosis was 31.5%. Prevalence of the three types of endometrioses included peritoneal/superficial endometriosis, ovarian endometriotic cyst/endometrioma and deep infiltrating endometriosis was 13.8%, 9.8%, and 4.8%, respectively. Three hundred sixty-one women 36,8% in the surgical group and thirty-one women 13.3% in the community treatment group (unexposed to surgery, population cohort) were diagnosed with incident endometriosis. The pelvic pain, infertility and early age at menarche to be a consistent risk factor for endometriosis in both the operative and population cohorts. Data analysis showed that odds were decreased for gravidity, parity, and BMI. Factors that increased the odds of endometriosis diagnosis included dysmenorrhea, older age at first sex, pelvic pain as a surgical indication for laparoscopy, and higher education. Our study findings demonstrate the high prevalence of endometriosis among women in Ukraine. The pelvic pain, infertility and early age at menarche to be a consistent risk factor for endometriosis in both the operative and population cohorts.
Associated Conditions · Extrapelvic Endometriosis
Abdominal wall endometriosis in Ukraine: A multicenter study
Salmanov AG et al., 2025 · Wiadomosci lekarskie (Warsaw, Poland : 1960) · Free to read
To estimate the incidence of abdominal walls endometriosis in Ukraine and review the clinical findings, imaging results, and histopathology of patients who have had cesarean scar endometriosis. Materials and We performed multicentre retrospective cohort study from January 2020 to December 2024. The study involved 27 hospitals from 10 regions of Ukraine and included 9,157 reproductive women who had a painful mass in their previous abdominal surgery scar area. Definitions of endometriosis were adapted from the WHO. Among 9,157 patients, 387 (4.2%) abdominal walls endometriosis (AWE) were observed. Of all cases 82.2% women had cesarean scar endometriosis and 17.8% had scar endometriosis related to gynecologic surgical procedure. The incidence of AWE associated with history of cesarean section, gynecological abdominal hysterectomy and laparoscopic procedures was 6.3%, 2.3%, and 1.2%, respectively. The main symptoms of scar endometriosis were palpable abdominal mass (100%) and cyclic pain (86.8%). The latency period between cesarean section procedure and of cesarean scar endometriosis (CSE) symptom onset was 31.8 ± 23.6 months. The duration between the onset of symptoms of CSE and this surgery was 28.7 ± 25.4 months. The diagnosis of CSE was made through a histopathological examination. In Ukraine abdominal wall endometriosis (AWE), is a relatively uncommon entity that usually develops at the site of a surgical scar that occurs after obstetric or gynecologic surgeries. In our study the most frequently of all AWE cases was cesarean scar endometriosis.
Related research
Infections · Vaginal and Cervical Infections
HEALTHCARE-ASSOCIATED BACTERIAL VAGINOSIS AFTER GYNECOLOGICAL SURGERIES AND ASSOCIATED ADVERSE PREGNANCY OUTCOME IN UKRAINE
Salmanov AG et al., 2023 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
The To determine the prevalence of healthcare-associated bacterial vaginosis after gynecological surgeries and associated adverse pregnancy outcomes in Ukraine. Materials and Multicenter retrospective cohort study was conducted from January 2019 to December 2021 in eleven medical centers from eight regions of Ukraine. Vaginal cultures were obtained preoperatively from 3,502 women undergoing gynecologic surgery. Diagnosis of Bacterial Vaginosis is based on the Nugent and Amsel criteria. Healthcare-associated bacterial vaginosis (HA BV) was diagnosed in 1,498 of 3,502 women, giving a prevalence rate of 42.8%. HA BV was significantly associated with preterm birth (risk ratio [RR], 2.68; 95% confidence interval [CI], 1.44-4.98), miscarriage (RR, 6.11; 95% CI, 3.22-14.11), low birth weight (RR, 3.20; 95% CI, 1.29-7.94), and premature rupture of membranes (RR, 6.75; 95% CI, 3.11-14.67). The HA BV after gynecological surgeries prevalence is high in Ukraine, with a concomitant adverse pregnancy outcome, including preterm birth, low birth weight, premature rupture of membranes, and miscarriage. A significant number of cases of bacterial vaginosis are associated with long-term use of antibiotics to treat post-operative infections.
Infections · Vaginal and Cervical Infections
PREVALENCE OF AEROBIC VAGINITIS AFTER GYNECOLOGICAL SURGERIES AND ASSOCIATED ADVERSE PREGNANCY OUTCOME IN UKRAINE
Salmanov AG et al., 2023 · Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
To determine prevalence of Aerobic Vaginitis (AV) after gynecologic surgery, risk factors and antimicrobial resistance of responsible pathogens, and adverse pregnancy outcomes in Ukraine. Materials and Multicenter retrospective cohort study was conducted from January 2020 to December 2022 in fifteen medical clinics from eight regions of Ukraine. Smears were analyzed using Donders' classification method and Dong's modified AV diagnosis for Gram stains. Definitions of HAIs were adapted from the CDC/NHSN. Antibiotic susceptibility testing of bacteria was determined by Kirby-Bauer disc diffusion test according to the protocol of the EUCAST. Prevalence of AV among women's undergoing gynecologic surgery in Ukraine was 68.7%. Of the total AV cases, 70.3% were in non-pregnant and 29,7% in pregnant women. The most common pathogen of AV was Escherichia coli, followed by Enterococcus faecalis, Streptococcus agalactiae, Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Among the S. aureus strains, 11,6% of MRSA (Methicillin resistant S.aureus) were isolated whereas none of the CoNS were cefoxitin resistant. History of vaginal infection, history of post-operative infection and antibiotic use acted as an important risk factor of AV incidence rate. The presence of AV worsened pregnancy outcomes, by increasing the incidence of preterm birth, the premature rupture of membranes, miscarriage, neonatal jaundice, and neonatal infection. Aerobic Vaginitis after gynecological surgeries in Ukraine is a common medical problem in women that is associated with significant morbidity, adverse pregnancy outcome, and hence frequent medical visits.
Infections · Vaginal and Cervical Infections
VULVOVAGINAL CANDIDIASIS AFTER GYNECOLOGICAL SURGERIES AND ADVERSE PREGNANCY OUTCOME IN UKRAINE: A MULTICENTRE STUDY
Salmanov AG et al., 2023 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
The To investigate the epidemiology and microbiology of vulvovaginal candidiasis (VVC) after gynecological surgeries, and adverse pregnancy outcomes in Ukraine. Materials and Multicenter prospective cohort study was conducted from January 2020 to December 2022 and recruited pregnant and non-pregnant women aged 15-65 years who had sought medical help for vaginal dysbiosis the seven medical clinic from five regions of Ukraine. Between 2020 and 2022, 2,341 women were followed in gynecological practices, and 1,056 (41.5%) women were diagnosed with VVC during the same period. Of the total VVC cases, 31.9% were in non-pregnant and 68.1% in pregnant women. The use of antibiotics (OR=3.48), use hormonal contracep¬tives (OR=2.75) and pregnancy (OR=1.13) were associated with an increase in the risk of VVC diagnosis. Diabetes mellitus (OR=0.44) were additional risk factors. The most common pathogen of VVC was C. albicans, Nakaseomyces glabratus (C. glabrata), followed by Pichia kudriavzevii (C. krusei), C. parapsilosis, C. tropicalis, C. kefyr, C. guillieromondii, C. lusitaniae, and C. rugosa. We found no significant difference in adverse pregnancy outcomes between Candida-positive and Candida-negative women. Vulvovaginal candidiasis after gynecological surgeries in Ukraine is a common medical problem in women that is associated with significant morbidity, and hence frequent medical visits. High prevalence rate of vulvovaginal candidiasis in the present study warrants, the importance of conducting continuous epidemiological surveys to measure changes in species distribution from C. albicans to non-albicans Candida species in Ukraine.
Infections · Vaginal and Cervical Infections
Epidemiology and risk factors for healthcare-associated maternal peripartum infections in Ukraine: results a multicenter study
Salmanov AG et al., 2024 · Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
To estimate the frequency of different types of healthcare-associated maternal peripartum infections and their risk factors among women in Ukraine. Materials and Multicenter prospective cohort study was conducted in nine regional perinatal centers of Ukraine between January 1, 2021, to December 31, 2023. The criteria for specific healthcare-associated maternal peripartum infections (endometritis, episiotomy infection, and maternal sepsis) site were adapted from the CDC/NHSN case definitions. Surveillance was performed during the hospitalization period and up to 30 days after hospital discharge. A total of 3600 deliveries by the vaginal route were performed during the study period, 600 (16.7%) maternal peripartum infections were observed. Of all maternal peripartum infection cases, 79.7% were detected after hospital discharge. The most common maternal peripartum infections include endometritis (54.8%), episiotomy infections (34.4%), and maternal sepsis (10.8%). According to the multivariate logistic regression analysis, the body mass index >25, placenta previa, premature rupture of membrane, prolonged rupture of membranes, manual removal of the placenta, multiple vaginal examinations, bacterial vaginosis, aerobic vaginitis, gestational diabetes mellitus, and anemia during pregnancy were independent risk factors for maternal peripartum infections. Results this study suggest a high prevalence of healthcare-associated maternal peripartum infections in Ukraine. Several factors have been associated with increased risk of maternal peripartum infections, including pre-existing maternal conditions, placenta previa, prolonged rupture of membranes, and spontaneous or provider-initiated conditions during labour and childbirth.
General Gynecology › Infections › Pelvic Inflammatory Disease · Infections and the Reproductive Microbiome › Systemic and Emerging Infections › Infection in Pregnancy
Aidyn G Salmanov, Volodymyr V Artyomenko, Andrey O Semenyuk, Serhii Yu Vdovychenko, Svitlana M Korniyenko, Vitalii S Strakhovetskyi, Yuliia V Strakhovetska, Olga V Gorbunova, Olena V Doroganova, Orusia A Kovalyshyn, Andriy I Chubatyy, Igor V Kokhanov, Victoria Ye Butska, Alexander G Tymchenko, Ihor Paliga
A Salmanov, V Artyomenko, A Semenyuk, S Vdovychenko, S Korniyenko, V Strakhovetskyi, Y Strakhovetska, O Gorbunova, O Doroganova, O Kovalyshyn, A Chubatyy, I Kokhanov, V Butska, Alex Tymchenko, A Tymchenko, I Paliga
PMID 41518179 41518179 DOI 10.36740/wlek/214791 10.36740/wlek/214791 Salmanov et al. 2025, Salmanov 2025