№ 12 (2017)

The article presents analysis of the available modern literature data on the prevalence and features of pharmacotherapy of iron deficiency anemia (IDA) during pregnancy. The review includes data from foreign and domestic articles. The search was conducted by keywords in Internet databases, released to the public, Pubmed and other resources. The urgency of the problem of IDA in pregnant women, possible consequences of this complication, directions of pharmacological correction are described. Methods for increasing the efficacy and safety of therapy with iron preparations, including the use the dosage forms with improved pharmacokinetic characteristics, are presented. It is necessary to carry out further research in the field of development and clinical application of the most effective and safe drugs for the correction of IDA in women during pregnancy and lactation.

Chronic pelvic pain (CPP) is a common, independent disorder, whose incidence in women of reproductive age reaches 15%. CPP is the cause of 10% of all visists to the gynecologist, 40% of laparoscopies and 10-15% of hysterectomies. Chronic pelvic pain negatively affects the quality of life of the female patient and disrupts her social adaptation. The article presents modern concepts of the etiology, pathogenesis and clinical manifestations of chronic pelvic pain in women, taking into account the neuroanatomy of the pelvic organs. Particular attention is paid to differential diagnosis of diseases leading to CPP, modern methods of examination of patients. The author describes modern methods of treatment, pathogenetically substantiated and symptomatic, and emphasizes the necessity of relief of chronic pain syndrome. In 50-60% of cases, the cause of CPP in women of reproductive age is endometriosis; the article presents tactics of management and methods of treatment of pelvic pain in endometriosis. Advantages of use of non-steroidal anti-inflammatory drugs - selective cyclooxygenase-2 inhibitors - in dysmenorrhea, endometriosis, chronic inflammatory processes and other causes of pelvic pain are described; prescription of the rectal form of the selective cyclooxygenase-2 inhibitor - Amelotex suppositories - is justified.

The article is devoted to the actual problem of modern medicine - prevention and treatment of posthysterectomic syndrome (PHES). The study was aimed to the evaluation of the oxidative stress markers and the mental status of women with PHES on the background of treatment with human placenta hydrolyzate (HPH). The study included 62 perimenopausal women (age, 46.3±0.56 years) 3 weeks to 3 months after hysterectomy without adnexectomy (group I, n=30) and with unilateral adnexectomy (group II, n=32) not receiving menopausal hormone therapy. Severity of PHES was determined using a modified menopausal index, mental status was assessed by Beck psychometric scale, the severity of anxiety disorders - using Spielberger scale, and the level of oxidative stress markers (superoxide dismutase, glutathione peroxidase) - by enzyme immunoassay. Patients were treated with HPH for subcutaneous use (Melsmon, Japan) according to the scheme. It was found that PHES after hysterectomy is occurred in women with severe asthenia, chronic fatigue and mental distress against the background of a dysregulation of the antioxidant functions. Metabolic correction with HPH allowed to reduce the frequency of vegetovascular manifestations from 86.7 to 16.7% in the group I and from 84.4 to 21.9% in group II (p<0.001), relief the manifestation of depression and anxiety, normalize the oxidative stress indices. It is emphasized that early diagnosis of PHES, personali-zed therapy with metabolic correction in a timely manner can not only relief the neuroveg-etative symptoms, but also correct the signs of mental distress and other age-related diseases on the background of progressive oxidative stress.

The most frequent manifestations of endometriosis include endometrioid ovarian cysts (EOCs). Their recurrence continues to be one of the most urgent problems of modern gynecology. The article presents the results of the study, which was aimed to the evaluation of mmunohistochemical method of steroid hormones and Ki-67 proliferation factor expression in the walls of primary and recurrent EOCs for the determination of prognostic markers of recurrence after surgical treatment. The study included women with newly diagnosed COE, including 69 patients with COE without recurrence of the disease, and 12 women with a recurrence of the cyst in a catamnesis. A significant increase in proliferative factor Ki-67 expression in stromal and glandular tissues in the COE walls with subsequent relapse was established. It is shown that if the level of estradiol expression is more than one and a half points, and Ki-67 in the glandular tissue >24.5%, then the recurrence of ECJ in the absence of hormone therapy can be predicted with high sensitivity (93.3%) and specificity (100%). Taking into account the results of the study, it is possible to prescribe the long courses of hormone therapy not in all patients, but only in cases of predicted recurrences of EOCs.

The article presents the results of the study which was aimed to the comparison of the infectious complications after abdominal birth and the health of newborns in women who received cefazolin 2.0 g for prophylaxis before skin incision and intraoperatively after clamping the umbilical cord. The time of preventive administration of cefazolin with planned abdominal birth (30 minutes before the skin incision or after clamping the umbilical cord) does not significantly affect the risk of postoperative infectious complications. Cefazolin, despite prolonged use in obstetric practice, remains the drug of choice for the prevention of infection in the ares of surgical intervention in cesarean section.

The article presents the results of a comparative analysis of the serum zinc levels in patients with different pregnancy outcomes. It was revealed that in patients with non-developing pregnancy, zinc deficiency occurs in 79.5%, and in recurrence cases - in 88.5%. The reasonability of determining the zinc levels in the postabortal period and correcting the zinc deficiency at the stage of pregravid preparation is shown.