№ 12 (2016)

Abnormal discharges from the genital tract, which are associated with such diseases as bacterial vaginosis or vaginitis of different etiologies, are one of the main reasons for visiting a obstetrician-gynecologist. In Russia, an adequate differential diagnosis of these conditions is not carried out in routine practice, remaining the prerogative of the of individual research works. This article provides details on the capabilities of modern molecular and genetic techniques to radically change the approach to the laboratory diagnosis of inflammatory and noninflammatory dysbiotic diseases of lower genital tract in women. Examples of the use of a new approach to routine clinical practice are discussed. Currently, comprehensive approach involving characterization of vaginal microflora and analysis of mucosal immunity, is developing. The introduction of new diagnostic tools necessitates a change of the clinical paradigm and attitudes towards treatment and prevention.

The article presents current literature data on the epidemiology, pathogenesis and approaches to the treatment cholelithiasis and biliary sludge during pregnancy. The results of authors’ own observations allowing to identify risk factors for cholelithiasis in pregnant women are discussed. Despite transient nature of cholelithiasis and biliary sludge and spontaneous regression postpartum in part of patients, those cases in which calculi and in biliary tract microlites persist and cause complications requiring further surgery should be taking into account. The effectiveness and safety of ursodeoxycholic acid in combination with cholekinetics/choleretics in the treatment and prevention of biliary sludge in pregnant women are demonstrated. In the presence of biliary sludge, dynamic monitoring of the gallbladder functions during pregnancy and the postpartum period, especially in high-risk groups, and, if necessary, carrying out a long-term and / or repeated courses of treatment are feasible.

The article presents a comprehensive approach to support of breastfeeding, the main elements of which include a healthy diet for pregnant and lactating women and assistance in support of lactation at all stages of care: in prenatal clinics, maternity hospitals and children’s polyclinics.

The study included 125 peri- and postmenopausal women planning for surgical correction of urinary incontinence/pelvic organ prolapse with laboratory-confirmed clinical atrophic vulvovaginitis. All patients underwent surgery. Of these, 95 patients were treated with a combined drug containing estrogen, progesterone and lactobacilli at two stages: during 30 days prior to surgery (2 capsules a day for 20 days and 1 capsule a day for 10 days) and 30 days after the surgery (2 capsules per week). The control group consisted of 30 patients. At all stages of the treatment, subjective and objective assessment of the severity of urinary disorders and urogenital atrophy (UDI-6 questionnaire), assessment of their impact on the quality of life of patients (IIQ-7 questionnaire), evaluation of bacteriuria and vaginal biocenosis, the frequency of adverse events and postoperative complications were carried out. Patient’s baseline characteristics in studied groups were comparable. Both at the stage of preoperative preparation and in postoperative period, group of patients who received therapy showed a significant improvement in the clinical manifestations of urinary disorders (74 vs 100% at the end of the 1st stage of therapy, 28 vs 39% at the end of the 2nd stage of therapy, p<0.05), quality of life (70±7.7 vs 88±5.6 and 29±4.4 vs 38±2.9; p<0.05), symptoms of urogenital atrophy (43% vs 100 and 35 vs 71%; p<0.05) and indicators of the vaginal biocenosis (normocenosis - 88% vs 48 and 95 vs 62%; p<0.05). In addition, there was a trend towards decrease in the severity of bacteriuria in the group receiving treatment (64% vs 79 and 39 vs 45%; p<0.05). However, there were no significant differences in terms of the recovery of urination after surgery and length of hospital stay, as well as in the number of postoperative complications. Thus, application of a drug containing estrogen, progesterone and lactobacilli improves urogenital menopausal symptoms in women planning for the surgical correction of urinary incontinence and genital prolapse and it can be recommended in the pre- and postoperative periods.

Retrospective study of dietary habits in the same women during pregnancy and lactation was performed. Particular attention was paid to compliance with the principles of a balanced diet: dietary regimen, gentle processing of food, restriction of the use of salt and smoked products, the use of vitamin and mineral complexes and specialized products. Consumption of products was assessed by frequency method. Analysis of actual nutrition of pregnant and lactating women has shown that only 40-60% of them use the diet foods such as milk and dairy products, meat, cereals, bakery products regularly. More than 70% of women regularly consume vegetables and fruits. It should be noted that less than 15% of women regularly consume fish, while the sausages are regularly used by more than 25% of women. More than 40% of pregnant women regularly include in diet spicy, salty, smoked, fried foods and dishes. More than 20% of pregnant women and more than 40% of lactating women do not use vitamin and mineral complexes. Specialized products in the diet are rarely used in this category of women, as opposed to the lactogenic teas, which are used by almost 50% of women, indicating a good awareness of products that stimulate lactation. It was found that the body weight of newborns whose mothers during pregnancy used vitamin complexes with vitamin content at least 80-100% of the recommended daily requirement, was not significantly different from the body weight of newborns whose mothers did not use vitamin complexes during pregnancy. It is shown that variations in a set of products used by women during pregnancy and lactation, were similar, indicating conservatism of feeding behavior and dietary habits of women during pregnancy and lactation, as well as the need for regular training for healthy eating principles and individual work with women for organization of their nutrition during pregnancy and lactation. Measures to improve the nutrition of pregnant women and nursing mothers are developed.