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编号 1 (2018)
- 年: 2018
- 文章: 25
- URL: https://journals.eco-vector.com/0300-9092/issue/view/6406
Articles
PATHOPHYSIOLOGICAL MECHANISMS OF OBSTETRIC ANTIPHOSPHOLIPID SYNDROME
摘要
To analyze the data of modern scientific literature on the possible pathophysiological mechanisms responsible for the development of obstetric antiphospholipid syndrome (APS), which are confirmed by the results of in vitro and in vivo experiments and histopathological studies. Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed and eLIBRARY on this topic. Results. Since thrombotic events cannot explain all obstetric manifestations of APS, it is suggested that there are other pathophysiological mechanisms associated with the direct effect of antiphospholipid antibodies on the development and function of the placenta and its complement-mediated inflammation. Conclusion. Understanding the pathogenetic mechanisms extends the possibilities of targeted therapy in patients with APS, especially in those resistant to conventional therapy.
Obstetrics and Gynecology. 2018;(1):5-12
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FETAL MACROSOMIA: PREDICTION, PREVENTION, AND TACTICS FOR MANAGEMENT OF PREGNANCY AND DELIVERY
摘要
Objective. To analyze the data available in the literature on current methods for prediction, prevention, and management tactics of pregnancy and delivery in fetal macrosomia. Material and methods. The review includes the data of Russian and foreign articles published in the past 10 years and found in Pubmed on this topic. Results. The risk factors of fetal macrosomia and current methods for its predicting were analyzed in healthy pregnant women and patients with metabolic disorders. The focus was on the role of lipids as biomarkers for the development of macrosomia. The review considers the main methods for the diagnosis, prevention, and tactics for management of pregnancy and delivery in fetal macrosomia. Conclusion. There is a need for further investigations of the pathogenetic features of the development of macrosomia in order to elaborate new approaches to its early prediction and prevention. The improved tactics for management for pregnancy and delivery in this complication will improve maternal and perinatal outcomes.
Obstetrics and Gynecology. 2018;(1):14-20
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New trends in nutritional support for pregnancy
摘要
Objective. To analyze the role of specialized vitamin and mineral supplements (VMSs) in supporting pregnancy women on the basis of published meta-analyses and clinical trials. Material and methods. Relevant publications over the last decade were selected in the Science Citation Database PubMed and additionally in Google Scholar. Results. There is a positive trend in giving up less digestible and, in some cases, more toxic inorganic forms of micronutrients for more highly bioavailable ones. The equally important features are the use of biologically active forms of micronutrients and the increasing intake of omega-3 polyunsaturated fatty acids in the composition of VMSs for pregnant women. Conclusion. The use of highly bioavailable VMSs by pregnant women allows primary prevention of fetal malformations. The presence of omega-3 polyunsaturated fatty acids in VMSs reduces the risk of visual dysfunctions and perinatal encephalopathy in the fetus.
Obstetrics and Gynecology. 2018;(1):21-28
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THE PATHOGENESIS AND DIAGNOSIS OF ADENOMYOSIS: CURRENT ASPECTS
摘要
Objective. To analyze the data available in modern scientific literature on the pathogenesis of adenomyosis and the newest possibilities of its early diagnosis. Subjects and methods. The review included the data of articles from international peer-reviewed databases. Different points of view on the studied topic were examined. Results. The basic mechanisms responsible for the development of adenomyosis were described. The possibilities of current methods for its early diagnosis were analyzed, by taking into account the main pathogenetic mechanisms. Conclusion. The change in the connecting zone (CZ) thickness and the invasion of the endometrium into the myometrium may represent very early-stage adenomyosis. The possibility for imaging the lateral boundaries of the CZ on the same 3D ultrasound image has greatly expanded the potential of echography in detecting the early changes not only in the outer myometrium, but also in the inner myometrium.
Obstetrics and Gynecology. 2018;(1):29-34
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CHOICE OF COMBINED ORAL CONTRACEPTION FOR ADOLESCENT GIRLS AND YOUNG WOMEN
摘要
Objective. To carry out a systematic analysis of the data available in the literature on the use of combined oral contraceptives (COCs) by adolescent girls and young women. Material and methods. Foreign and Russian articles published in the past 15 years were sought in the international citation database Pubmed for their analysis. Results. The paper highlights the factors influencing adherence to COC use in adolescent girls and young women (a fear of complications and side effects, the lack of responsibility in young women, a low level of awareness of the benefits and risks of hormonal contraception). It is shown that after adequate medical consultation, the use of COC by adolescent girls and young women can offer additional health and quality of life benefits. Conclusion. The correct choice of a dosage regimen and hormonal components in the composition of COCs is a guarantee for adherence to contraception in young female users. COCs containing drospirenone and a microdose of ethinyl estradiol (a 24/4 regimen) are one of the most attractive combinations for most adolescent girls and young women today.
Obstetrics and Gynecology. 2018;(1):35-40
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PROGNOSTIC SIGNIFICANCE OF MRI IN DIAGNOSING DIFFERENT TYPES OF PLACENTA INCRETA
摘要
Objective. To estimate the diagnostic value of different MRI signs in determining the extent of placental invasion. Subjects and methods. This retrospective cohort study enrolled 32 patients with morphologically verified diagnosis of placenta increta. All the cases were divided into three groups according to the histological findings of the extent of placental invasion: 1) placenta accreta (n=10); 2) placenta increta (n=20); 3) placenta percreta (n=2). Results. Central placenta previa was 8.5 times more common in patients with placenta increta. While marginal previa was more characteristic of placenta accreta (p=0.015). Other clinical and anamnestic parameters showed no impact on the extent of placental invasion. Multiple lacunae prevailed 9 times more frequently in placenta increta while more than 1-2 lacunae were detected in placenta accreta. Dark bands are also a more characteristic sign for deeper placental invasion (p=0.04). Conclusion. The investigation showed a link between the form of abnormal placentation and placental invasion. Multiple lacunae and dark bands are significant MRI markers for the diagnosis of placenta increta.
Obstetrics and Gynecology. 2018;(1):41-47
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PREDICTION OF THE COURSE OF DIFFERENT TYPES OF PYELONEPHRITIS IN PREGNANT WOMEN FROM INNATE IMMUNITY INDICATORS
摘要
Objective. To investigate innate immunity indicators in pregnant women with different types of pyelonephritis. Subjects and methods. A total of200pregnant women underwent an examination involving the identification of the clinical and anamnestic characteristics of the course of pregnancy, the laboratory diagnosis of inflammatory diseases, and the study of innate immunity indicators. Results. The maximum content of complement C3 and C4 components was seen in a group of pregnant women with newly diagnosed pyelonephritis (36.3±2.07 and 58.3±4.0 ng/ml). The concentration of C1 (110.2±19.1 ng/ml) was decreased in a group of those with gestational pyelonephritis. The phagocytic indices (Pi) (PI, 23.2±0.41%; phagocytic activity index (PAI), 1.02±0.03) were lower in a group of pregnant women with uncomplicated pyelonephritis than in a group of normal pregnancy (50.5±4.2 and 2.9±0.7). Conclusion. The changes in immunity indices are more marked in patients with pyelonephritis f irst detected during pregnancy than in those with chronic pyelonephritis, in whom an exacerbation occurred during pregnancy.
Obstetrics and Gynecology. 2018;(1):48-52
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USE OF A DOME-SHAPED SILICONE OBSTETRIC PESSARY IN PREGNANT WOMEN WITH PLACENTA PREVIA AS A METHOD FOR PREVENTION OF EARLY PRETERM DELIVERY
摘要
Objective. To evaluate the efficiency of using an obstetric pessary in combination of progesterone in a group of pregnant women at high risk for miscarriage and placenta previa. Subjects and methods. A total of 217 pregnant women at high risk for preterm delivery with placenta previa were examined. A study group (Group A) consisted of 81 pregnant women, in whom a comprehensive approach with a Dr. Arabin obstetric pessary was used in combination with micronized progesterone; a comparison group (Group B) included 136 patients who received micronized progesterone only. During the investigation, each group was divided into subgroups according to the type of placenta previa: Groups IA1 (n = 13), IB1 (n = 50) with complete placenta previa, Groups IA2 (n = 25), IB2 (n = 37) with incomplete placenta previa and Groups A3 (n = 43), IB3 (n = 49) with low placentation. Resu1ts. The highest rate of complications as bleeding was detected in Group B: in 48.6 (18/37) of the patients with incomplete placenta previa during pregnancy and in 80.0% (40/50) of the parturient women with complete placenta previa during labor. Bleeding during pregnancy was three times less frequently seen in the group of patients who used a Dr. Arabin in combination with progesterone than in that receiving progesterone only: 11.1% (9/81) versus 33.1% (45/136), respectively (χ2 = 7.416; p = 0.006). Early premature deliveries occurring at less than 34 weeks’ gestation was 2.7 times less frequently observed in Group A than in Group B (χ2 = 4.678; p = 0.031). Placental migration was diagnosed 1.8 times significantly more often in Group A, mainly in the low-placentation subgroup (χ2 = 4.369; p = 0.037) due to the lower resistance index in the arcuate arteries and to the change in the anterior uterocervical angle. Conclusion. The combined approach to managing patients with placenta previa at high risk for miscarriage reduces the frequency of early preterm delivery at 34 weeks’ gestation by 2.7 times and the risk of bleeding during labor by 3 times. Placental migration occurs in 48.1% of the pregnant women with placenta previa when a Dr. Arabin obstetric pessary is used.
Obstetrics and Gynecology. 2018;(1):54-60
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ADVANTAGES OF USING A RAPID DIAGNOSTIC TEST SYSTEM TO DETERMINE PLACENTAL α1-MICROGLOBULIN IN THE CERVICAL CONTENTS FOR IDENTIFICATION OF INCIPIENT/THREATENED PRETERM LABOR
摘要
Objective. To determine whether a combined use of a test system to determine the content of placental α-microglobulin (PAMG)-1 in cervical contents and ultrasonic cervicometry (UZC) can improve the identification of spontaneous preterm births. Subjects and methods. A group included 172 pregnant women with clinical presentations of threatened/incipient preterm labor at 24-33 weeks’ gestation. Results. There is a strong relationship between the positive test result and the likelihood of delivery on the following 0-14 days. Conclusion. The combined use of ultrasound cervicometry and PAMG-1 test leads to an increase in their diagnostic efficiencies.
Obstetrics and Gynecology. 2018;(1):62-68
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EVALUATION OF THE CARDIOVASCULAR SAFETY OF MENOPAUSAL HORMONE THERAPY IN EARLY POSTMENOPAUSAL WOMEN
摘要
Objective. To evaluate the cardiovascular safety of long-term use of a combination of 1 mg 17β-estradiol and 2 mg drospirenone (DRSP) (1 mg E2/2 mg DRSP) in early postmenopausal women. Subjects and methods. A total of 162 early postmenopausal women were examined and divided into 2 groups: 1) 84 patients who were on menopausal hormone therapy (MHT) with 1 mg E2/2 mg DRSP (Angeliq) (a study group); 2) 78 women who did not receive MHT (a control group). The follow-up period was 5.2 years. The severity of abdominal obesity and oral glucose tolerance test and hemostatic parameters were estimated. Results. Long-term MHT is associated with a significant decrease in waist circumference (WC) and waist-hip ratio (WHR) throughout the follow-up period. The control group showed a significant increase in WC and WHR. Long-term MHT is associated with a decrease in the probability of developing carbohydrate metabolic disturbances (OR, 0.42; 95% CI, 0.17-1.04) and in the incidence of hypertension (OR, 0.69; 95% CI, 0.34-1.38). The circadian blood prof ile was normalized in women on MHT. The changes in endothelium functional activity (von Willebrand factor antigen, antithrombogenic activity of the vascular wall) suggest that long-term MHT with 1 mg E2/2 mg /DRSP had no negative impact on the endothelium. Conclusion. The combination of 1 mg E2/2 mg DRSP used in the long-term MHT in early postmenopausal women demonstrated its efficacy, safety, and additional positive effects.
Obstetrics and Gynecology. 2018;(1):69-76
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COMPREHENSIVE REHABILITATION IN WOMEN AFTER LATETERM ABORTION FOR MEDICAL REASONS
摘要
Objective. To evaluate the efficiency of a comprehensive approach to the rehabilitation of women after late-term induced abortion. Subjects and methods. A total of 60 women at less than 22 weeks’ gestation were rehabilitated after termination of pregnancy for fetal congenital malformations incompatible with life. The women were divided into 2 groups: a study group, in which the developed comprehensive rehabilitation was carried out, and a comparison group, in which the measures were limited to regulatory documents. Results. Delayed complications were observed in 13.3 and 40.0% of the women in the study and comparison groups, respectively (p = 0.041) (these in the study group were 3 times less frequently detected than in the comparison group); long-term sequences were seen in 10 and 53.3% of the examinees, respectively (p = 0,000); these in the study group were 5.3 times less often observed than in the comparison group). Conclusion. The implementation of complex rehabilitation measures showed that delayed and late complications were observed 3 and 5.3 times more rarely, respectively, than the application of the traditional approach. The management tactics should include not only conventional therapy for complications, but also prophylactic use of contraceptives, suppression of lactation, donation of folic acid, and physiotherapy procedures.
Obstetrics and Gynecology. 2018;(1):77-82
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EVALUATION OF THE EFFICACY AND SAFETY OF A CONTRACEPTIVE CONTAINING ETHINYLESTRADIOL IN COMBINATION WITH CHLORMADINONE ACETATE
摘要
Objective. To evaluate the efficacy and safety of an agent containing ethinylestradiol (EE) in combination with chlormadinone acetate (CMA) in contraceptive-needing patients within the framework of the pharmacological epidemiological observational project. Subjects and methods. The study enrolled 161 female patients needing contraception. All patients had no contraindications to combined oral contraceptives (COCs) and conditions in which COCs should be used with caution. All the women took EE in combination with CMA in a 21/7 cyclic regimen for contraception. To evaluate its efficacy and safety, the occurrence of pregnancy was assessed within 6 months of EE/CMA intake. To estimate safety parameters, the changes in body weight, blood pressure, and hemostatic parameters that characterized the risk of hypercoagulation disorders were assessed. Results. During the follow-up, no pregnancy occurred in the patients included in the study. Significant changes in weight gain, blood pressure, and improvement in the blood coagulation potential were not observed. The hormonal contraceptive with CMA demonstrated an additional positive effect on the women’s emotional state. Conclusion. The findings may conclude that EE in combination with CMA is highly effective and safe and may also highlight its additional positive effects.
Obstetrics and Gynecology. 2018;(1):83-90
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THE CLINICAL AND GENETIC PARALLELS OF VITAMIN D PROVISION AND BENIGN BREAST DISEASES
摘要
Objective. To investigate vitamin D (VD) levels in women with various forms of benign breast diseases (BBD) in relation to their clinical features, as well as the impact of CYP2R1 rs2060793polymorphism on the level of VD. Subjects and methods. Genotyping for the locus -1559 T>C gene CYP2R1 (rs2060793) was carried out by realtime polymerase chain reaction in 247 women (131 healthy individuals and 116patients with BBD). The level of VD was estimated by chemiluminescence immunoassay in 100patients with BBD and 75 healthy women. Results. 88% of the patients with BBD had a low blood VD level while 53% of them had VD deficiency that correlated with the severity of the disease. The lowest VD provision among the healthy women is characteristic of homozygous carriers of C alleles in the CYP2R1 gene. The patients with BBD had a persistent VD def icient state, regardless of the variant of CYP2R1 gene polymorphism. Conclusion. VD deficiency in women with BBD has a direct impact on the clinical symptoms of the disease and is unassociated with the genetic polymorphism in the CYP2R1 gene.
Obstetrics and Gynecology. 2018;(1):91-95
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METASTATIC BRAIN INVOLVEMENT IN GENITAL CANCER
摘要
Objective. To analyze a group of patients with brain metastases from genital cancer. Material and methods. From 2002 to 2016, the investigators followed up 26 patients aged 25 to 74 years who had brain metastases from genital cancer. Results. Brain metastases occurred more frequently in patients with ovarian malignancies, then in those with uterine corpus and cervical cancer. The shortest time from primary tumor detection to diagnosis of brain metastases was 1 month in a patient with chorion carcinoma; that averaged 27.5 months in those with ovarian malignancies, 34.2 and 41 months in those with uterine corpus and cervical cancer, respectively. Conclusion. Metastatic brain involvement has clinical features that should be taken into account in the clinical and laboratory diagnosis for the early detection of brain metastases and subsequent treatment.
Obstetrics and Gynecology. 2018;(1):96-101
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Sexual development of aboriginal and immigrant girls in the Republic of Khakassia: Somatometric aspects
摘要
Objective. To identify the ethnic features of sexual development of girls in Khakassia. Subjects and methods. The survey involving somatometry and assessment of sexual development, by using the scale designed by J. Tanner, covered 1,035 aboriginal (Mongoloid, Khakassian) and 847 immigrant (white) girls at the age of 11 to 18 years. Results. Indigenous girls had lower absolute values of height and weight, buttocks circumference, and pelvic bone dimensions than immigrant peers. The pubertal growth surge occurs during the 13th year of life in Khakassian girls and a year earlier in white girls. The mean age of breast development, onset of pubic hair, and menarche was 11.8, 12.0, and 12.8 years for immigrant girls and 12.1, 12.2, and 12.9 years, respectively, for Khakassian girls. There was a delay in the formation of Ma5 and P5A in a significant proportion of the girls surveyed; 1.3% of the Khakassian girls and 2.4% of the white girls had an irregular menstrual cycle by the age of 18 years. Conclusion. The revealed regional characteristics of pubescence predetermine the search for reasons that negatively affect the reproductive potential of the rising generation.
Obstetrics and Gynecology. 2018;(1):102-106
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PREECLAMPSIA AND LOWER MATERNAL MORTALITY IN RUSSIA
摘要
Objective. To study the most important aspects of maternal mortality from preeclampsia, eclampsia, the current clinical features of the most severe forms of this complication of pregnancy, as well as main defects in rendering qualified medical care, including those in the development of complications. Subjects and methods. A confidential audit of maternal mortality was conducted in different regions of the Russian Federation in 2013-2015. A total of 270 anonymous copies of primary medical records were analyzed. Results. The features of development and progression of the most severe forms of preeclampsia and eclampsia were identified. The development of preeclampsia in the presence of previous extragenital diseases was seen in most clinical cases. Early clinical manifestation is characteristic in the vast majority of women; and the non-classical (atypical) clinical picture of the disease is also common. Conclusion. Practical activities are proposed, which are aimed at reducing maternal mortality from preeclampsia in Russia.
Obstetrics and Gynecology. 2018;(1):107-112
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GIGANTOMASTIA: CLINICAL CASES, ULTRASOUND CHARACTERISTICS
摘要
The review highlights the issues showing the possibility of diagnosing gigantomastia, a rare breast disease of unknown origin and uncertain prognosis, and that of using the methods for its treatment and prognosis. Material and methods. The review includes the results of cases of foreign and Russian meta-analyses found in Pubmed on this topic. The authors give their own observations, the clinical examples of the results of diagnosis and treatment, the use of the up-to-date ultrasound imaging technologies for different types of gigantomastia. Results. The data obtained in the meta-analyses of studies, as well as the diagnostic characteristics of different types of gigantomastia were generalized, and the results of the authors’ own observations were analyzed. Ultrasound examination was shown to play a role in the primary, differential diagnosis and dynamic monitoring of patients with this pathology. Conclusion. The findings, the above results, and their analysis just now and in the short term can be used as criteria for the diagnosis of gigantomastia in the clinical practice of physicians, mammologists, obstetricians/ gynecologists, ultrasound diagnosticians, radiologists, endocrinologists, and oncologists, to largely determine further treatment policy and to predict outcomes.
Obstetrics and Gynecology. 2018;(1):113-120
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INTERFERON INDUCERS IN THE COMBINATION THERAPY OF UTERINE CERVICAL DISEASES IN PERSISTENT HUMAN PAPILLOMAVIRUS INFECTION
摘要
Background. Despite the ability to visualize the type of precancer and its long period and sufficiently sensitive, specific, and inexpensive screening tests (cytology testing and determination of human papillomavirus ((HPV) with the possibility of combining them in liquid technology), the incidence of invasive cancer increases and the neglect of the latter is not reduced. Objective. To improve therapy for a treatment outcome for uterine cervical diseases with persistent HPV infection. Subjects and methods. To solve the set tasks, the investigators examined 50 patients with cervical diseases and persistent HPV infection (retrospective medical history data, Pap test, HPV testing, extended colposcopy, cervicoscopy, radiosurgical conization of the cervix with subsequent morphological examination). Results. The proposed package of measures, based on antiviral therapy with allokin-alpha and on a differentiated approach to choosing a surgical treatment, could obtain the maximum positive treatment result. The complete and incomplete effects after combination treatment were observed in 94 and 6% of the women, respectively. Conclusion. Thus, the proposed package of measures, based on antiviral therapy with allokin-alpha and a differentiated approach to choosing a surgical treatment, could obtain the maximum positive treatment result.
Obstetrics and Gynecology. 2018;(1):121-126
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THE PRESENT-DAY VIEW ON THE PATHOGENESIS AND PREVENTION OF LIFE-THREATENING COMPLICATIONS OF PREGNANCY AND DELIVERY IN PATIENTS WITH MESENCHYMAL DYSPLASIAS (MARFAN SYNDROME, EHLERS-DANLOS SYNDROME, RENDU-WEBER-OSLER SYNDROME)
摘要
Objective. To systematize the current medical knowledge and experience in the management of pregnancy and delivery in patients with mesenchymal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome, Rendu-Osler syndrome). Material and methods. The paper includes the data of foreign investigations and medical guidelines for this problem, which have been published in the past 5 years. Results. The paper describes the molecular bases of each syndrome, diagnostic criteria, and their clinical manifestations in various organs and systems: musculoskeletal and cardiovascular systems, the organ of vision, etc. Such patients during pregnancy are at extremely high risk for life-threatening complications. Conclusion. A successful outcome of pregnancy requires early diagnosis and a multidisciplinary approach throughout during pregnancy and delivery.
Obstetrics and Gynecology. 2018;(1):127-134
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CHARACTERISTICS OF DIET FOR PREGNANT WOMEN
摘要
Objective. To carry out a systematic analysis of the data available in the current literature on dietary recommendations for pregnant and breastfeeding women and on the role of trace elements in maternal nutrition. Subject and methods. The review includes the data of foreign and Russian articles published in the past 15 years and found in PubMed on this topic. Results. This paper describes essential trace elements and vitamins for pregnant and breastfeeding women. It notes the importance of changes in maternal trace element status and their impact on the programming of offspring development. Conclusion. It is necessary to modify existing dietary patterns with the goal of more widely introducing the most currently available enriching and correcting products and drugs. Only these integration efforts will maximize the preventive effect of maternal and child nutrition.
Obstetrics and Gynecology. 2018;(1):135-140
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Ectopic pregnancy associated with fallopian tube adenocarcinoma
摘要
Background. Fallopian tube cancer (FTC) is an extremely rare, difficult diagnostic malignant disease of the female reproductive system. The world literature describes single cases of FTC concurrent with tubal pregnancy. Description. The paper describes a clinical case of diagnosed FTC after surgical treatment for tubal pregnancy. Patient P., aged 34 years, who had complained of vaginal bleeding and tensive pain in the right iliac region, was admitted to the Bakhrushins Brothers City Clinical Hospital. After complete clinical and laboratory examinations diagnosed right ectopic pregnancy, emergency surgical treatment was performed as laparoscopy and rightsided tubectomy. The postoperative period was uncomplicated; the patient was discharged home in satisfactory condition. Histological examination revealed the growth of well-differentiated fallopian tube adenocarcinoma and confirmed the diagnosis of ectopic pregnancy. The diagnosis was verified by immunohistochemical study Conclusion. Preoperative diagnosis of FTC is extremely difficult; therefore the elaboration of a clear algorithm for the diagnosis and treatment of this condition is one of the important tasks in gynecologic oncology.
Obstetrics and Gynecology. 2018;(1):142-147
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GIANT OVARIAN MUCINOUS CYSTADENOMA IN A 54-YEAR-OLD WOMAN
摘要
Background. Ovarian cancer develops from benign tumors in 80% of cases during long-term follow-up. According to the literature, the incidence of giant ovarian cystadenoma is extremely low. There are difficulties in verifying these ovarian tumors. Description. The paper describes a rare clinical case of a 54-year-old patient with giant ovarian cystadenoma. It depicts the patient’s clinical, medical history, laboratory, and instrumental data and demonstrates the technical complexities of surgery and the features of postoperative management. Conclusion. The early diagnosis and timely treatment of ovarian tumors will be able to avoid technically difficult surgical interventions and to minimize postoperative complications, which will substantially improve the prognosis of the disease. Such operations should be performed by a surgeon having extensive surgical experience and high qualification.
Obstetrics and Gynecology. 2018;(1):148-153
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DEVELOPMENT OF ATYPICAL HEMOLYTIC UREMIC SYNDROME AFTER GYNECOLOGIC SURGERY: CLINICAL PRESENTATIONS, DIAGNOSIS, AND TREATMENT
摘要
Objective. To carry out a systematic analysis of the data available in present-day literature on the types of thrombotic microangiopathy, the trigger for which may become gynecologic surgery. Material and methods. The paper describes an extremely rare case of atypical hemolytic uremic syndrome (aHUS) in gynecological practice, which has an unusual clinical picture including deep vein thrombosis with pulmonary embolism (PE) in addition to acute renal failure. Results. The paper depicts a differential diagnostic search between different types of thrombotic microangiopathy, which could be induced by gynecologic surgery. It considers all the triggers or complement-activating conditions, which result in aHUS, identifies the stages of diagnosis, and views the complexity of treatment, the choice of therapeutic approaches, and a quick response to targeted therapy with eculizumab. Conclusion. The given clinical case showed a manifestation of aHUS with deep vein thrombosis and PE after diagnostic uterine curettage in the patient. Pathogenetic treatment initiated on day 7 after the onset of aHUS could rapidly achieve not only a hematologic response, but also restore the function of the kidneys and other affected organs.
Obstetrics and Gynecology. 2018;(1):154-160
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Resolution of the XVIII All-Russian Scientific and Educational Forum “Mother and Child”
Obstetrics and Gynecology. 2018;(1):161-163
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Stanislav V. Pavlovich
Obstetrics and Gynecology. 2018;(1):164-164
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