No S5 (2011)

32 women suffered from chronic pyelonephritis who have wished to interrupt pregnancy in first trimester were investigated. We made the determination of placental (SP-I, β-hGC) and endometrial (glicodelin A, IGFBP-I) proteins concentration in serum, and exposed characteristics proteinsynthesizing function of chorion and endometrium.

The search of the causes, underlying pathological processes of the human embryogenesis, has the leading position among studies in the field of Human Reproduction. Therefore we conducted analysis of the epigenetic phenomenon, which regulates expression of the genes, involved in the placenta formation processes. It was suggested, that abnormal methylation levels of human endogenous retroviruses ERVWE1 и ERVFRDE1 genes in chorionic tissue of the placenta fetal part can be associated with pathological course and adverse outcome of the pregnancy.

The associations of the most frequent carriages of allelic thrombogenic mutations and polymorphisms in women with chorion presentation in the first trimester of pregnancy living in the Altai region were determined in this research. 300 women were investigated and divided into three groups. It depends on the chorion presentation: the main group consisted of 50 patients with complete chorion presentation in the first trimester of pregnancy and the lack of migration in the second trimester; the comparison group included 150 pregnant women with chorion presentation in the first trimester and further migration in the second half of pregnancy; control group had 100 pregnant women with physiological placentation. The frequency of thrombogenic mutations and polymorphisms in women from the main group was in 82,0% of cases, whereas in the comparison group these genetic defects were revealed in 36,8% of cases and there were 3% in the control group. Intergenic associations were detected in 58% of cases, whereas in the comparison group in 7,3% of cases and they were absent in the control group. The condition of reproductive and somatic health of women with chorion presentation was also evaluated.

We identified 158 patients with first-trimester PAPP-A and b-HCG < 5th centile. We excluded multiple pregnancies and major anomalies. 15,2% had evidence of fetal growth restriction and had significantly higher rates of gestational hypertension, preterm birth, low birth weight, 1-min Apgar score < 7, neonatal intensive care.

There are studies about the gestation course, childbearing and perinatal outcomes of women with treated recurrent prematurity, various reproductive onsets and different by clinical progression options for threatened miscarriage in the 1 st trimester. The elaboration distinctions of their fetoplacental ineptitude are full-scale assessed. There is also an estimation of the health status of their children in the dynamics of the first 3 years of life, which includes the cardiovascular system testing.

In this article attention is spared to the most meaningful factors, wich influence on the early miscarriage. The estimation of influence of abnormal changes auto-antibodies on probability of implantation and progressive pregnancy. The role of violations of the hemostasiological system is considered during the in vitro fertilization. Prevalence of innate thrombophilias, circulations of antiphospholipidies antibodies (AFA) hyperhomocistieinemia are analysed,. The analysis of these coagulograms is conducted, the analysis of agretogograms, when the correction of violations in the system of hemostasis is finished, is contucted as well.

The complex examination and correction system of pregnancy loss was elaborated according to the experience of examination and treatment for pregnancy miscarriage, assotiated with incompetent cervix in 126 women. The system made it possible to prolong the pregnancy up to the delivery with viable newborn in 96,9% cases, full-term in 84,1%.

We studied the course of pregnancy at 159 patients with flu A(H1N1)09 on early pregnancy terms. Control group consisted of 100 pregnants without flu which were in I-st trimester of gestation in the center of a pandemic flu during the same time. Reproductive losses in I trimester of pregnancy complicated by flu A(H1N1)09 were 32,1% (in a control group – 0%). Fetus malformations and spontaneous abortions are more often arose at a flu on 5–8 th weeks of gestation. There is a dependence between the mother's fever and early losses of pregnancy. There is not interrelation between a hyperthermia at the pregnant and fetus malformations. Oligohydramnion, II-nd stage of fetal hypotrophy and preterm labor are more often developed subsequently at patients with a flu A(H1N1)09 in I trimester of pregnancy. Preventive maintenance and flu treatment by an antiviral drags of Arbidolum in early terms of pregnancy reduces frequency of spontaneous abortions and doesn't render teratogenic influence.

Examination of 20 women with normal pregnancies and 27 women with pregnancies, complicated with gestosis (47 pregnant women total) was done to develop endothelial and immunological prognostic criteria of gestosis in the first trimester of pregnancy. A complex study of the immunological status and vasodilating function of the endothelium was carried out. As a result, a risk group for gestosis development was detected and early prognostic markers were determined.

This paper is concerned with the possible factors of risk of development of gestosis, which can be detected during the early stages of pregnancy. Detection of several factors of risk presupposes a detailed examination of the pregnant women at consultancies, with subsequent performance of preventive and therapeutic actions.

Intracardial and vascular hemodinamics changes during normal pregnancy, pregnancy induced hypertension and preeclampsia are summarized. For the first time a syndrome frequency of disproportional weight of left ventricle myocardium (WLVM) has been studied in pregnant women with a preeclampsia and pregnancy induced hypertension. A higher self –descriptiveness of tissue Doppler visualization method has been demonstrated while analizing LV myocardium diastolic function versus traditional Dopplerometry.

The analysis of reproductive and somatic health, current of I trimester of pregnancy at women with a low index of mass of a body is carried out. Features of the anamnesis, a state of health before the present pregnancy are taped. Authentically significant complications in I trimester are established. Conducting schemes at a stage pregravidal preparations and in I trimester of pregnancy for the purpose of depression of frequency of possible complications are offered.

The retrospective analysis of medical histories of 1374 women was carried out; from them the control group (170 women), the group of women with hyperemesis gravidarum (101 women) were chosen. Based on the theory of adaptive reactions by L.H. Garkavi, E.B. Kvakinoj and M.A. Ukolovoj (1978, 1990), the assessment of the adaptation condition was carried out: type of adaptive reaction, level of reactivity and level of health in points for women during pregnancy, labor and postpartum period using the author's computer software «Antistress». A leukocytic formula was used as an alarm indicator of adaptative reaction and criteria of the conditions synchronization. The received results have revealed authentic dependence between level of health and the frequency of hyperemesis gravidarum development.

In order to assess the effectiveness of different options antithrombotic therapy in the prevention and treatment of gestational complications in patients with thrombophilia were treated with 671 patient, 117 of whom received treatment since pregravidal phase and 554 — only during pregnancy, as treatment (II–III trimester). Depending on the version of the antithrombotic drug therapy were formed 3 groups: patients in the treatment of which used low molecular weight heparins, low molecular weight heparins in combination with drugs acetylsalicylic acid and heparinoids (sulodexide). All medications administered at the minimum therapeutic doses. Way to set the material – a simple method of randomization envelopes. The effectiveness of treatment was evaluated by dynamic changes in the hemostatic system and the nature of the circulation in the maternal-placenta-fetus. The study found that both the pregravidal stage and during pregnancy sulodexide monotherapy is the preferred unnecessarily, impacting on all links of the hemostatic system, can significantly improve the overall capacity of the blood coagulation and thereby reduce the proportion of severe complications of gestation.

This paper assesses the preventive effect of administration of human immunoglobulin (pentaglobin) during the early stages of pregnancy in the presence of factors of risk of development of a systemic inflammatory response, such as viral infection, acute sinusitis, or bronchitis during the waves I and II of cytotrophoblast invasion; innate and acquired trombophilia; and autoimmune diseases. The proposed therapy contributes to localization of the inflammatory process, and reduction of the risk of development of gestosis and perinatal losses.

The article discusses pregnancy course and labor outcomes in women with chronic hypertension. We divided all pregnant into two groups in dependence on the kind of antihypertensive treatment. The main group treatment was nebivalol monotherapy, the control group took combined medications in different compositions (atenolol, methyldopa, nifedipin). We revealed nebivalol therapy significantly decreased the number of gestational complications and adverse perinatal outcomes and in pregnant with chronic hypertension.

The problem of decrease in parent death rate and search of ways of the decision of organizational, medical-diagnostic, tactical problems dictates necessity of carrying out of the analysis of errors of the akushersko-gynecologic help, and also attention accentuation on revealing of preventable cases of death rate during pregnancy, sorts or in the postnatal period. All it will allow to define reserves in decrease and preventive maintenance of parent death rate.

50 reproductive age women with oligomenorrhea in puberty and 15 women with normal menstrual cycle were examined. Objective examination and definition of prolactin, gonadotropic and thyrotropic hormones of hypophysis, cortisol, estradiol and progesterone were made. For the reason of the results pregravidary preparation program was advanced. This program included differentiated usage of estrogen-gestagen drugs and pure gestagen drugs. Such preparation leaded to decrease frequency of abortion risk and placental insufficiency, which were diagnosed by definition of decreasing choriogonadotropin β-subunit level in 11–12 weeks, unconjugated estriol and common choriogonadotropin level in 16–20 weeks, and, also, echographic signs.

It was carried out clinico-ultrasound inspection of 550 women, which were suffering from the early-term pregnancy losses. Pathomorfological research of aspiration biopsies of endometrium from these women was perfomed. The analysis of ultrasound characteristics at various types of the early-term pregnancy losses is resulted. Comparison of the results of ultrasonic and morphological methods of research in diagnostics of chronic endometritis is executed. The ultrasound «masks» of chronic endometritis are defined, the greatest diagnostic value a method within the limits of identification hysteroscopic macrotypes (gipo-, hyperplastic and admixed) is shown.

Chronic endometritis (CE) is a cause of a reproductive loss in 30-35% of the cases (E.B. Johnston-Macannany et al., 2009). 80–90% of patients are women of reproductive age. Today there is no strict algorithm of observing women with CE, including all links of pathogenesis. Latent course, absence of clinical manifestation, lack of self-descriptiveness of routine methods of diagnosis define difficulties of prevention and treatment of CE. Studying possible mechanisms of development of CE, creation of the most effective methods of diagnostics, treatment and rehabilitation of the patients with such a disease are the most urgent problems of modern obstetrics and gynecology.

In the context of current demographic situation the problem of miscarriage has become especially acute. Traditionally various aspects of miscarriage and the preterm labor have been viewed through the prism of the woman’s health. At the same time, according to the present reproductive medicine, a proper approach to this problem includes taking into account the state of health of both future parents. In contrast to infertility, male reproductive health in couples, suffering from miscarriage, and its contribution to the outcome of pregnancy, ending without childbirth, hasn’t been determined yet. The article includes the results of studying reproductive health in 62 men – husbands of women, suffering from miscarriage at different terms. The role of chronic viral infection as a cause of spermatogenesis disturbances has been shown.

During the recent years miscarriage has remained one of the most important problems in obstetrics and perinatology. Its makes up almost 20% of all confirmed pregnancies, and this figure doesn’t tend to decrease, despite multiple methods of diagnosis and treatment, suggested in the recent years.

The article includes Moscow’s healthcare achievements in obstetric aid and neonatology for the recent decade, as well as certain proposals on the further optimization of the regional Maternity and Child Welfare Service, aimed to reach the maximal functioning efficiency of the service.

The article includes literature data concerning the course of pregnancy in juvenile women, as well as the research data from the study, aimed to estimate the total perinatal risk in case of juvenile pregnancy. The perinatal and obstetric outcomes in the juvenile pregnants, living in the East District of Moscow, were studied.