No S6 (2012)

The relevance of prediction and early diagnosis of preeclampsia is due to the fact that the current preeclampsia continues to be the most complicated section of obstetrics, being one of the leading causes of high maternal and perinatal morbidity and mortality. This article provides an overview of the literature on combined prenatal screening of preeclampsia.

The results of operations of cesarean section in twin gestations with the extraction of fetuses in the intact amniotic sac and the condition of newborns were analyzed. Main (experimental) and control study groups of abdominally delivered twin pregnant have been formed, and also two groups of the children delivered by these operations. Analysis of efficacy of the extraction in the intact amniotic sac method on the newborns’ showed that the Apgar score in the experimental group was higher, artificial lung ventilation duration, duration of hospital stay was less, and prevalence and severity of neurological disorders was less. Duration of operations increased by less than 5%. Hence condition of multifetal newborns improvement expected while using this method.

The information on alternative tactics in puerperium with the using of modern perinatal technologies (MPT) accumulated only for urgent delivery. Nevertheless, the experience of local researchers is confirming the effectiveness of the reorganization tactics in postpartum period and reducing maternal and neonatal ID (inflammatory disease) on the basis of priority, it would seem natural to human nature, is very optimistic. In this regard, our objectives is: to improve the outcomes of preterm delivery through the introduction of modern perinatal technologies. The contingent of the study were four groups formed according to the gestational age at the time of preterm delivery and adherence to policies MPT in the postpartum period. Couples are selected on the basis of — mother — newborn (101 pair). Criteria for inclusion in the group: singleton pregnancy, preterm delivery in 28—36 weeks of pregnancy. Implementation of MPT provided the reduction in reporting cases of mothers in the ID one and a half times ( p < 0,05), neonates (with hospital infection) — nearly seven times ( p < 0,05). We believe it possible to reduce episodes of neonatal ID associated with a positive effect of continuous skin contact of mother with a newborn. The basis for this conclusion is the meta-analysis demonstrating a significant reduction in mortality in preterm infants weighing less than 2000 g, and their severe morbidity, especially from infections.

The article indicated the relevance of the problem of miscarriage as a social and a medical point of view. The analysis not only obstetrics and gynecology, but also the social-hygiene, household factors that influence the course of pregnancy in the I trimester. The study identified characteristics of somatic and reproductive health and is composed of medical-social characteristics of women with threatened miscarriage in the I trimester at this stage.

Due to the adverse demographic situation in the Russian Federation (Russian Federation) keep the urgency questions of protection of reproductive health of women. Its regional features are necessary for considering when developing regional programs on optimization of the specialized help to pregnant women. In article the comparative analysis of the main indicators of the statistical reporting of the Russian Federation, the Karachaevo-Circassian republic (KChR) and Primorsky Krai (personal computer), pregnant women characterizing health (The Russian Federal Service of State Statistics, in dynamics for 2005—2010 gg is presented.) It is revealed that, despite improvement of the majority of indicators, level of their population health in the Russian Federation remains low — at every third anemia, at everyone a heel — diseases of urinogenital system, at every tenth — diseases of system of blood circulation is registered. Feature of KChR is higher frequency of diseases of a thyroid gland and the venous complications tending to growth, low level of diseases of urinogenital system, and also growth of incidence by a preeklampsiya, eklampsiy at lower general frequency of complications of pregnancy hypostases, a proteinuria and gipertenzivny frustration. Regional indicators of the personal computer which distinguish lower frequency of diseases of system of blood circulation, venous complications and stably low level of complications of pregnancy a preeklampsiya, eklampsiy, as a whole more reflect the all-Russian tendencies. The problems demanding adoption of organizational decisions, threat of interruption of the pregnancy, which half of cases, irrespective of the region are, it is the share of terms of 22—37 weeks, and the diabetes complicating a current of a gestatsiya, incidence which in the Russian Federation and in the personal computer steadily grows, and in KChR, despite decrease, disorder of an indicator still corresponds to the all-Russian.

On the basis of studying of perinatal outcomes at 183 pregnant women, and also data of ultrasonic, kardiotokografic researches, dopler in system vessels mother placenta a fetus, histologic research of a placenta, were drawn conclusions that in group of the patients having surgical abortion in the anamnesis, manifestation of placentary insufficiency and failures of childbirth, are much more expressed, in comparison with group of patients at which medical abortion was earlier made.

92 patients with genital endometriosis and diagnosed infertility were clinically examined and went through molecular-genetical testing and therapy. Complex therapy included laparoscopic surgery and the course of hormonal therapy (gonadotrophin releasing hormone agonists, combined oral contraceptives). The effect of the therapy increases as increases the possibility of pregnancy in the presence of IL2 gene T-330G TT polymorphism variant and IL4 gene C-590T CC polymorphism variant in the genotype of a woman. The decreased effect of infertility treatment with the diagnosed endometriosis is associated with the presence of the hazardous genotype combination: IL2 gene T-330G GG polymorphism and IL4 gene C-590T TT polymorphism.

It was done estimation the condition of ovarian reserve of 51 women 15—25 years old in dynamic after surgery and conservative treatment for benign non-inflammatory ovarian diseases, by identification of AMG level, ovarian volume and count of antral follicles in each ovarian immediately and after 6 month after treatment. Complemented the existing ideas about the negative effects on the state of ovarian reserve intervention and specific nosology.

For the purpose of increasing of the efficiency of antibioticotherapy of urinary tract infections (UTI) among people of giving age in the conditions of High North were analyzed results of permanent checkup and treatment of 1109 patients. Chronic pyelonephritis combined with concomitant urolithiasis prevail among these people in the structure of permanent UTI. Acute and uncomplicated chronic pyelonephritis, acute and chronic cystitis among female prevail more than 2 times. Main agents of permanent UTI among men are S. epidermidis , S. saprophyticus , S. aureus ; main agents with women in uncomplicated UTI are E. coli , S. epidermidis , S. saprophyticus and S. aureus ; main agents of complicated UTI are E. coli , S. saprophyticus , S. epidermidis . Main uropathogens in vitro are more sensitive to gentamicin, ofloxacin, they are less sensitive to cefotaxime, ceftriaxone and ciprofloxacin. The largest share of resistant strains was indentified in vitro to traditionally used antibiotics for treatment of UTI among E. coli , the smallest share was indentified with S. aureus .

Mismanagement and lack of rehabilitation results in repeated surgery nodal forms of dishormonal breast diseases in the first 1.5 years after surgery, more than 27% of patients, and many of them carry sectoral resection of breast three times or more. Conducting post-operative medical rehabilitation and personalized comprehensive treatment of patients with breast achieves clinical improvement in 89.4% of patients, to prevent the progression of their diffuse forms of dishormonal breast diseases, a decrease of 64.7% frequency re-formation of foci localized fibroadenomatosis and improve the overall clinical condition of by preventing or reducing the frequency of acute extra-and gynecological diseases in 2.43 times, which significantly improves the quality of life of women and contributes to the secondary prevention of breast cancer.

The retrospective analysis of patient's records of 54 patients with abdominalny sepsis, for the purpose of studying of features of the volemichesky status of dynamics of indicators of sokratitelny ability of a myocardium, preloading, post-loading and extra vascular water of lungs, and as for the purpose of an assessment of pro-gnostic value of these indicators is carried out. By means of technology of the modified termodilyutsiya of PiCCO plus (Pulsiоn Medical Systems», Germany) carried out monitoring of haemo dynamics and the volemichesky status. At implementation of the analysis of measurements, such as the index of extra vascular water of lungs (IEVWL), an index of intra chest volume of blood (IICVB), an index of global final and diastolic volume (IGFDV), an index of function of heart (IFS), an index of system vascular resistance (ISSS), established that negative dynamics of indicators of sokratitelny ability of a myocardium and IEVWL are failure prediktor at patients with abdominalny sepsis.

In this article questions of tactics of conducting childbirth at women with a hem on a uterus are considered. Results of a number of researches are given when conducting childbirth through natural patrimonial ways after operation Cesarean section, and also conditions for their performance. The analysis of conducting such childbirth from the legal point of view, as in Russia, and abroad.

Availability of pharmaceuticals in this country has caused not only a self-patients, but the “treatment” of pregnancy. The effectiveness of some medications commonly prescribed in pregnancy has not been proved, and the number of drugs taken by pregnant sometimes exceeds all reasonable limits. The only possibility that avoids undesirable effects of medicines during pregnancy is to minimize their number by an informed, responsible and impartial approach to the appointment of each drug.

In article the review of the literature devoted to a problem of diseases of a mammary gland at teenage age is presented, to possibilities of their treatment and prevention.

This article is about modern surgical tactics of treatment of puerperants with obstetric peritonitis after caesarian section. The most controversial questions of carrying out operation and the postoperative period are designated.