Summary
Annex 2 to Kyrgyz Cabinet Resolution No. 616 requires a gestational carrier to be aged 20–35, have at least one healthy child of her own, undergo medical genetic counselling and give written informed consent. It does not specify a maximum number of previous cesarean deliveries. Vita's published criteria for its Bishkek programme allow no more than one previous cesarean; a woman with two would therefore fall outside that institution's criteria. Other programmes must be checked individually. [1,2]
Pregnancy after two cesareans requires assessment of placenta accreta spectrum, cesarean scar pregnancy, uterine rupture and complications of repeat surgery. Implantation, placental growth and operative findings become assessable after conception or during surgery. An Ontario observational study also found more severe maternal morbidity among gestational carriers than among women conceiving without assistance or through ordinary IVF. These population associations cannot be added or multiplied with cesarean-related risks to calculate one candidate's risk. [8,9,13]
Pregnancy for oneself and embryo transfer as a gestational carrier have different decision and responsibility structures. The clinic can assess whom to treat before transfer; the carrier bears the pregnancy risk, while the intended parents establish parenthood. Selection involves health, informed consent, clinical judgement and arrangements for care at the delivery hospital.
1 Kyrgyz law and published institutional criteria
The relevant procedure is set out in Cabinet Resolution No. 616 of 14 October 2024. Adopted under Article 104 of the Law on Protection of Citizens' Health, the resolution approved three documents. Annex 2, the Procedure and Conditions for Use of Surrogacy, covers eligibility, procedural steps and contraindications. [1]
| Provision | Content | Relevance to selection |
|---|---|---|
| Paragraph 4 | The healthcare organisation signs a notarised agreement with the carrier and undertakes to provide ART. Pregnancy, delivery and postpartum observation are governed by the parties' agreement. | The clinic is a direct contractual party. |
| Paragraph 6 | Age 20–35, at least one healthy child of her own, medical genetic counselling and written informed voluntary consent. | Previous delivery mode is not specified. |
| Paragraph 7 | Intended parents meet pregnancy, delivery and postpartum expenses under the agreement; a bank account is opened for those funds. | Coverage and settlement depend on the agreement. |
| Paragraph 15 | The first procedural step is selection and examination of the carrier; the fifth is preparation of her endometrium. | Selection is a clinical step. |
| Paragraph 16 | Contraindications include physical or mental conditions precluding pregnancy, congenital abnormalities or acquired uterine cavity deformity, uterine benign tumours requiring surgery, acute inflammation and malignancy. | Whether a large niche constitutes acquired cavity deformity requires clinical assessment. |
Paragraphs 6 and 16 contain no cesarean-count restriction. Institutions can use stricter criteria in clinical selection; those criteria and the statutory conditions should be recorded separately. [1]
Published requirements vary. Vita in Bishkek allows no more than one cesarean. [2] Embrymama's current Kazakhstan candidate page lists age 20–35 and at least one child of her own, but does not state an explicit cesarean-count limit; exact eligibility should be confirmed in writing. [3] The ASRM/SART 2022 committee opinion recommends, ideally, no more than five previous deliveries, including no more than three cesareans, and at least one uncomplicated term pregnancy. [4] None of these numerical criteria alone guarantees acceptance.
| Source | Published condition |
|---|---|
| Kyrgyz Annex 2 | No numerical limit |
| Vita, Bishkek | ≤ 1 |
| Embrymama, Kazakhstan | No explicit numerical limit on the current candidate page |
| ASRM/SART 2022 | Ideally ≤ 3; total deliveries ≤ 5 |
Sources 1–4. Numerical eligibility never replaces complete assessment; this is not a national acceptance guarantee.
A candidate within the ASRM numerical recommendation still needs medical-history, uterine-cavity, psychological and legal assessment. Two previous cesareans exceed Vita's published limit. These standards serve different settings. Section 8 discusses how emergency-care arrangements enter risk assessment without claiming that they establish the sole reason for each institution's threshold.
In a June 2026 radio interview, Elmira Maksutova, head of the Marriage and Family Planning Centre at Kyrgyzstan's National Centre for Maternal and Child Health, explained that the country does not prohibit pregnancy after repeated cesareans. Women with three, four or five previous operations continue to give birth; clinicians provide surveillance and delivery care while recognising risks including rupture, miscarriage and failure to reach term. This is the position described in the interview. [5]
The interview concerns care during another pregnancy. Gestational-carrier selection occurs before embryo transfer, at a different decision point.
2 Uterine changes after cesarean delivery
The lower uterine segment scar
Cesarean delivery usually involves a transverse incision in the lower uterine segment, followed by closure after delivery. Healing forms a scar whose local structure and capacity to stretch may differ from intact muscle. Repeat surgery may involve the earlier scar region, but incision position and closure technique require the actual operative reports. The Chinese colloquial term for abdominal delivery refers here to cesarean delivery.
A niche and residual myometrium
Incomplete healing can leave an indentation communicating with the uterine cavity, called a cesarean scar niche or isthmocele. Residual myometrium is the muscle remaining between the base of the niche and the uterine serosa. A deeper defect can leave a thinner residual layer. Blood or fluid may collect in the niche; prolonged spotting after menstruation is a common presentation.
A meta-analysis published in 2024 included eight observational studies involving 10,873 IVF patients. Live birth was less frequent with a niche than after cesarean without a niche (adjusted odds ratio 0.62; 95% CI 0.53–0.72), and than after vaginal delivery (0.55; 95% CI 0.42–0.71). Intracavitary fluid was associated with worse outcomes. The comparison between previous cesarean without a niche and previous vaginal delivery did not show a statistically significant difference (0.74; 95% CI 0.47–1.15). The findings support distinguishing delivery history from an actual scar defect. [6]
Conceptual distinctions, not a diagnostic image or a prediction for one patient.
Adhesions and the interval between births
Abdominal surgery can produce adhesions between the uterus, bladder and abdominal wall. Their extent varies; routine ultrasound cannot show all adhesions, and some are fully defined only at repeat surgery.
The interval between deliveries is another history item. A study of 2,409 women with one previous cesarean, no previous vaginal birth and a term singleton trial of labour reported rupture rates of 2.25% when the interdelivery interval was at most 18 months and 1.05% at 19 months or longer. After adjustment, the shorter-interval group had approximately threefold risk (95% CI 1.2–7.2). The interval measured was between births, and the data concern trial of labour after one cesarean. [7]
3 Placental, scar and operative risks during pregnancy
Placenta accreta spectrum
Normally, the placenta attaches to decidua formed from the endometrium and separates after delivery. A defect at the scarred endometrial–myometrial interface can impair decidualisation and allow villi to extend into muscle or, in severe cases, through the serosa and into the bladder. This range is termed placenta accreta spectrum (PAS). Attempting to detach an abnormally adherent placenta can cause major haemorrhage.
A prospective US Maternal–Fetal Medicine Units Network cohort followed 30,132 women having cesareans without labour at 19 centres. [8] PAS rates at the first through sixth-or-later operation were 0.24%, 0.31%, 0.57%, 2.13%, 2.33% and 6.74%; hysterectomy rates were 0.65%, 0.42%, 0.90%, 2.41%, 3.49% and 8.99%. Among women with placenta previa, PAS rates at the first through fifth-or-later operation were 3%, 11%, 40%, 61% and 67%. The ACOG/SMFM 2018 consensus cites these findings. [9]
For a woman with two previous cesareans who has another cesarean, the relevant group is the third operation. Its overall PAS rate was 0.57%, compared with about 40% in the previa subgroup. The 40% estimate requires placenta previa together with a third cesarean; it is not the risk for every woman with two previous cesareans. [8,9]
| Current operation | PAS overall | Hysterectomy overall | PAS with previa |
|---|---|---|---|
| 1 | 0.24% | 0.65% | 3% |
| 2 | 0.31% | 0.42% | 11% |
| 3 | 0.57% | 0.90% | 40% |
| 4 | 2.13% | 2.41% | 61% |
| 5 | 2.33% | 3.49% | 67%* |
| 6+ | 6.74% | 8.99% | 67%* |
Silver 2006: 30,132 non-labouring cesareans; 723 women with previa. *The 67% estimate combines the fifth and later operations. Two prior operations correspond to current operation 3. The 40% estimate requires previa.
The ACOG/SMFM consensus states that an unremarkable ultrasound does not completely exclude PAS; clinical risk factors remain important. For known or strongly suspected PAS in stable patients suitable for planned delivery, it suggests considering delivery at 34 weeks 0 days to 35 weeks 6 days at a level III or IV maternal-care facility with an experienced multidisciplinary team. The generally accepted operation delivers the fetus and removes the uterus with the placenta left in situ. Acute bleeding may change timing; uterine-preserving approaches require specialist assessment. This planning involves prematurity and applies to PAS management, rather than to all pregnancies after cesarean. [9]
Cesarean scar pregnancy
Implantation at a previous cesarean scar is called cesarean scar pregnancy. A 2006 review of 112 published cases cited estimated frequencies of around 1 in 1,800 to 1 in 2,216 pregnancies. Diagnosis averaged about 7.5 weeks; painless vaginal bleeding was common. Six expectantly managed cases had serious outcomes, including three hysterectomies. These historical cases illustrate severity rather than the incidence in a contemporary surrogacy programme. Pregnancy location is principally assessed by early ultrasound after conception. [10]
Uterine rupture
In a 2010 systematic review, trial of labour after two cesareans versus one was associated with rupture rates of 1.59% versus 0.72%, and hysterectomy rates of 0.56% versus 0.19%. [11] A retrospective cohort from 16 US hospitals found greater major morbidity with trial of labour after two rather than one cesarean (adjusted odds ratio 1.61), and greater morbidity with trial of labour after two cesareans than elective repeat cesarean (adjusted odds ratio 2.26). [12] These estimates concern trial of labour. Planned repeat cesarean changes labour-related risk, while pregnancy scar risks and operative complications still require separate assessment.
Repeat cesarean surgery
In the same US network cohort, bladder, bowel and ureteric injury, ileus, postoperative ventilation, intensive-care admission, transfusion of at least four units, operative duration and hospital stay increased with cesarean number. [8] A third operation already carries additional risk, but the increase is not identical at every operation; more marked rises occurred at higher operation counts.
4 Research on gestational carriage and endometrial preparation
An Ontario population cohort of singleton births beyond 20 weeks in 2012–2021 compared unassisted conception (846,124), IVF (16,087) and gestational carriage (806). Severe maternal morbidity occurred in 2.3%, 4.3% and 7.8%, respectively. Propensity-score weighting yielded relative risks of 3.30 (95% CI 2.59–4.20) versus unassisted conception and 1.86 (95% CI 1.36–2.55) versus IVF. Hypertensive disorders, postpartum haemorrhage and preterm birth were also more frequent among carriers. Severe postpartum haemorrhage, severe preeclampsia and puerperal sepsis were important complications. Information about indications for using a carrier and gamete source was unavailable, and the mechanisms require further research. [13]
A gestational carrier usually carries an embryo genetically unrelated to her. Immune adaptation, embryo source and endometrial preparation are possible explanations under investigation, rather than established separate causes. A Japanese ART registry study included 224,043 singleton live births delivered vaginally after 22 weeks following single embryo transfer. Within frozen transfer cycles, PAS occurred in 1.4% of hormone-replacement cycles versus 0.11% of natural cycles (adjusted odds ratio 11.4; 95% CI 8.7–15.0). The registry lacked previous uterine-surgery history and included only vaginal births. It therefore cannot establish independence from cesarean scarring or quantify the joint risk of two previous cesareans and that preparation regimen. [14]
Paragraph 15 of Annex 2 lists endometrial preparation but does not mandate hormone replacement. [1] The regimen belongs in clinical assessment and informed discussion; the treating team determines medication.
| Ontario singleton births | Severe maternal morbidity |
|---|---|
| Unassisted conception · 846,124 | 2.3% |
| IVF · 16,087 | 4.3% |
| Gestational carriage · 806 | 7.8% |
| Japanese frozen-transfer vaginal births | PAS |
|---|---|
| Natural cycle | 0.11% |
| Hormone-replacement cycle | 1.4% |
Velez 2024 and Jwa 2024. The Japanese registry lacks prior uterine-surgery history. These rates cannot be combined to estimate risk after two cesareans.
5 What examination before transfer can establish
Selection usually includes blood count, coagulation, liver and kidney function, blood group and antibodies, infection screening, hormones, cervical screening and pelvic ultrasound. Hysteroscopy or saline-infusion sonography may be added when indicated, together with psychological evaluation. These assess present health and current uterine suitability for transfer.
| Area | Assessable before transfer | Not fully established before transfer |
|---|---|---|
| Uterine scar | Niche presence, size and residual myometrial thickness on transvaginal ultrasound or saline-infusion sonography | Ability to withstand late-pregnancy expansion |
| Placenta | Uterine cavity can be assessed before conception | Implantation site, scar coverage and PAS |
| Pelvic adhesions | Clues from history and symptoms | Full extent and bladder relationships, often found during surgery |
| Earlier operations | Incision, closure and infection history if operative records exist | Missing records can leave these details uncertain |
| Indication for cesarean | Records may identify preeclampsia, abruption or previa | Recurrence risk is harder to assess without records |
| Delivery resources | The hospital and contingency plan can be reviewed | Blood, personnel and intensive-care capacity actually available at delivery |
Examination detects some contraindications and evaluates the current uterus. Implantation site, placental coverage and subsequent growth become observable only during pregnancy; the full extent of adhesions may emerge during surgery. Findings therefore need interpretation alongside operative and obstetric history. [9]
A conceptual timeline; complications can appear earlier or later than a diagram suggests. A normal pre-transfer examination does not determine future implantation.
The reason for each cesarean matters. Preeclampsia, abruption or previa can have recurrence implications different from malpresentation or labour arrest. ASRM recommends at least one previous uncomplicated term pregnancy. [4] Records should identify each operation's indication. Missing records add uncertainty and can lead a programme to defer or decline acceptance.
6 Medical decisions before embryo transfer
When a woman with two previous cesareans is already pregnant for herself, clinicians assess, monitor and arrange an appropriate delivery location and plan. The pregnancy already exists, and care aims to reduce existing risk. Maksutova's interview describes this aspect of local care. [5]
Before a gestational-carrier transfer, the proposed pregnancy has not begun. The clinic and candidate decide whether to proceed; she retains authority over her medical care, and the clinic decides whether to provide treatment after assessment. The ethical principle of avoiding harm requires consideration of the proposed risk, alternative candidates and subsequent care arrangements.
Consent, selection and subsequent care each have their own role. This is an explanatory comparison, not a determination of legal liability.
The agreement and selection responsibility
Paragraph 4 requires a notarised agreement between the healthcare organisation and the carrier, under which the organisation undertakes ART. [1] Selection is therefore part of the clinical process undertaken by a direct contractual party.
If complications occur, records should explain known risk factors, assessment, selection rationale and risk communication. Liability for professional duties depends on applicable law and the facts. [15] Accepting someone with two previous cesareans, or a complication occurring, does not automatically establish illegality, negligence or criminal liability. A satisfactory examination also does not substitute for a documented selection rationale.
7 The carrier's autonomy and family
In pregnancy for oneself, the person deciding to conceive, bearing the risk and becoming the parent is usually the same person. She weighs risk and her reproductive wishes.
In gestational carriage, the carrier bears pregnancy and delivery risks; the intended parents seek parenthood, and she may receive agreed compensation. A parallel with living organ donation is that the person undergoing medical risk is not the direct treatment beneficiary, although each procedure has its own eligibility rules. Carrier selection pays particular attention to health, wishes and support.
Informed consent documents an informed voluntary choice. Financial needs or compensation may influence decisions; evaluation addresses pressure, understanding of complications and withdrawal arrangements. An economic motive does not automatically invalidate autonomy. Consent also does not replace professional judgement about reasonable selection.
The regulations require at least one healthy child of the candidate's own. [1] Assessment includes care arrangements for her existing family. Severe haemorrhage, hysterectomy or death can have lasting effects on her and her family; support, insurance and emergency-care arrangements need to be settled before treatment.
| Issue | Pregnancy for oneself | Gestational-carrier pregnancy |
|---|---|---|
| Beginning of pregnancy | Spontaneous conception or treatment for oneself | The clinic transfers an embryo genetically unrelated to the carrier |
| Decision | The person chooses pregnancy or treatment | Voluntary agreement by the candidate and a clinical decision to provide transfer |
| Physical risk | The pregnant person | The carrier |
| Parenthood | The pregnant person | Intended parents |
| Clinical decision | Care for an existing pregnancy, or evaluate proposed treatment | Assess acceptance before transfer |
| Review after complications | Whether risk was appropriately managed | Selection rationale as well as subsequent care |
8 Delivery resources and legislative developments
The fertility clinic and delivery hospital
The fertility clinic provides selection, transfer and early pregnancy care. Later antenatal care and delivery often move to an obstetric hospital or perinatal centre; paragraph 4 leaves observation arrangements to the agreement. [1] PAS management requires experienced obstetric and, where relevant, urological teams, substantial blood-product support, interventional services and critical care. ACOG/SMFM notes that published diagnosis and treatment outcomes from experienced centres may not generalise to less experienced facilities. [9]
| Reported Kyrgyz maternal deaths, 2024 | Share |
|---|---|
| Extragenital disease | 25% |
| Sepsis | 22.2% |
| Haemorrhage | 19.4% |
| Hypertensive disorders | 13.9% |
| Other causes | 19.5% |
36 reported deaths; 25.7 per 100,000 live births. Historical national data reported by 24.kg from the Electronic Healthcare Centre, not a hospital- or carrier-specific risk estimate.
Blood supply
In 2024, 24.kg interviewed the national blood centre and the Osh regional centre. It reported about 13 donors per 1,000 residents, potential seasonal shortages during summer, student holidays and Ramadan, and frequent shortages of Rh-negative blood. The Osh interviewee stated that relatives of patients accounted for up to nine in ten donors locally. [16] These are historical interviews with a regional component. Delivery planning needs the chosen hospital's current stock, transfusion process and massive-transfusion capability.
Maternal mortality data for 2024
Citing the Electronic Healthcare Centre, 24.kg reported 36 maternal deaths in 2024 and a rate of 25.7 per 100,000 live births. Extragenital disease accounted for 25%, sepsis 22.2%, haemorrhage 19.4% and hypertensive disorders 13.9%. [17] Haemorrhage, hypertension and infection also appear among severe outcomes in the Ontario carrier study. [13] These sources concern different countries, populations and outcomes. National causes of death cannot establish the risk at one hospital or for one carrier.
ASRM's numerical recommendation and care arrangements
ASRM's ideal maximum of three previous cesareans is not a promise of safety below that number. [4] ACOG/SMFM describes graded care, specialist teams and blood-bank support. [9] Care capacity, financial coverage and responsibility allocation can affect an institution's ability to accept risk. The cited evidence does not establish these as the proven cause of the countries' different numerical criteria. Assessment must concern the actual clinic and delivery hospital.
Legislative proposals and entry into force
In August 2026, Vesti.kg and Economist.kg reported two proposals to restrict foreign access to surrogacy, with initiators including Bolot Ibragimov, Chyngyz Azhibaev and Marlen Mamataliev. [18,19] Economist.kg quoted explanatory material stating that 138 of 153 surrogacy births registered in 2024–2025 were registered to foreign citizens. [18] The reports describe bills and public consultation. This review did not confirm official promulgation and entry into force of the corresponding restrictions. Actual programmes require the latest official rules and written institutional confirmation.
The proposals reflect discussion of women's health, children's rights and programme governance. Complications can create legal and reputational pressure; the institution itself must explain its particular rationale for excluding two previous cesareans.
9 Costs and plans for intended parents
Selection affects treatment, budgeting and travel for intended parents and the child.
- For known or strongly suspected PAS suitable for planned delivery, delivery at 34 weeks 0 days to 35 weeks 6 days may involve prematurity and neonatal-care needs. [9]
- Uterine rupture can cause acute fetal hypoxia; recognition and time to surgery matter.
- Scar pregnancy may require termination or specialist treatment. Families with few embryos need to consider the remaining embryos and whether another retrieval becomes necessary.
- Paragraph 7 allocates relevant pregnancy, delivery and postpartum expenses under the agreement. [1] Intensive care, transfusion and surgery beyond the initial budget require agreed coverage, authorisation and settlement arrangements.
- Serious complications may change treatment, birth-registration and return-travel timing.
| Item for written confirmation | Information to obtain |
|---|---|
| Cesarean history and interval since the last birth | Exact operation count and delivery dates |
| Indications and operative reports | Whether records exist and the reason for each operation |
| Scar assessment | Transvaginal ultrasound or saline-infusion sonography, niche findings and residual myometrial thickness |
| Endometrial preparation | Natural or hormone-replacement cycle |
| Embryo number | Whether single embryo transfer is used, as strongly recommended by ASRM for carrier cycles [4] |
| Delivery hospital | Name, care level and experience with PAS and major obstetric haemorrhage |
| Complication expenses | Included items, excess charges and who authorises them |
| Replacement candidate | Process, timing and costs if eligibility is not met |
10 Frequently asked questions
Does the regulation limit previous cesareans?
Annex 2 to Resolution No. 616 contains no numerical maximum. Vita's published limit is one. Whether a large niche constitutes acquired uterine cavity deformity depends on the clinical findings. [1,2]
What does normal scar thickness establish?
Non-pregnant residual myometrial thickness describes the scar at that examination. Assessment also considers the niche, cavity fluid and operative records. One measurement cannot establish future implantation, placental growth or response to uterine expansion.
How are previous uncomplicated births considered?
They provide useful history; another pregnancy still has new implantation, placental and operative risks. In Silver's previa subgroup, PAS rates at the second and third cesareans were 11% and 40%. [8]
How do consent and selection responsibility fit together?
Consent documents disclosure and voluntary choice. The clinic still has responsibility for candidate selection, the care plan and reasonable risk assessment.
Which risks can single embryo transfer reduce?
It helps reduce multiple-pregnancy risk and is strongly recommended by ASRM in carrier cycles. [4] It does not eliminate scar pregnancy or PAS. A single embryo can also split, so obstetric monitoring remains necessary.
How should ASRM guidance and local criteria be applied?
ASRM's ideal maximum of three cesareans is clinical guidance; Vita's one-cesarean maximum is an institutional eligibility criterion. Their scopes differ, and the actual clinic's complete assessment governs treatment acceptance.
What assessment follows one previous cesarean?
The interval between births, surgical indications, scar niche and current treatment plan all remain relevant.
11 Selection conclusions and written documentation
Acceptance after two cesareans depends on the actual programme's criteria and complete clinical assessment. Vita's published criteria exclude that history; Annex 2 and ASRM's opinion state different conditions. [1,2,4]
Medical assessment
Repeat cesarean delivery is associated with increasing PAS and operative complications. Examination before transfer identifies some scar problems; implantation, placental growth and operative conditions require later assessment. Carrier and preparation-regimen studies provide additional information, but do not calculate their joint risk with two previous cesareans.
Autonomy and responsibility
The carrier bears pregnancy risk and retains medical decision-making authority. The clinic has professional responsibility for selecting treatment; intended parents meet financial and related arrangements under their agreement. Informed consent and reasonable selection both belong in care.
Subsequent care
Current written arrangements should verify delivery personnel, blood supply, critical care and referral capacity. Historical national statistics and legislative proposals provide context within their own dates and source limits.
Before signing, the programme can document its cesarean-count requirement, review of both operative records, preparation regimen, delivery hospital and complication expenses. These documents connect selection with subsequent care.
Organise the history and delivery arrangements
FS can help families assemble programme criteria, operative records, delivery-hospital information and expense terms. The fertility and obstetric teams assess eligibility and medical care.
References and original sources
Official regulations, programme criteria and key studies reviewed on 15 October 2026. References 5 and 16–19 are interviews or news reports with their own dates. Legislative proposals are distinguished from promulgated rules.
- Kyrgyz Cabinet Resolution 616, Annex 2 (official text, 2024)
- Vita: candidate requirements for the Bishkek programme
- Embrymama: published requirements for Kazakhstan
- ASRM/SART: Recommendations for practices using gestational carriers (2022)
- Kaktus.media: interview with Elmira Maksutova (2 June 2026)
- Vitagliano et al.: Isthmocele and IVF success, meta-analysis (2024)
- Shipp et al.: Interdelivery interval and uterine rupture (2001)
- Silver et al.: Maternal morbidity with repeat cesareans (2006)
- ACOG/SMFM: Placenta accreta spectrum consensus (2018)
- Rotas et al.: Cesarean scar ectopic pregnancies (2006)
- Tahseen and Griffiths: VBAC after two cesareans, systematic review (2010)
- Macones et al.: Outcomes after two cesareans (2005)
- Velez et al.: Severe maternal and neonatal morbidity among gestational carriers (2024); ICES research summary
- Jwa et al.: ART-associated PAS after vaginal delivery (2024)
- Kyrgyz Criminal Code: reference text on professional duties; unofficial reproduction
- 24.kg: blood-centre interviews (14 June 2024)
- 24.kg: maternal mortality in 2024, reporting Electronic Healthcare Centre data (5 November 2025)
- Economist.kg: legislative proposal (20 August 2026)
- Vesti.kg: legislative proposal (11 August 2026)
General medical and regulatory information; individual clinical and legal assessment is required.