Vol 7, No 1 (2020)

Clinical lectures
Ectopic pregnancy
Gadayeva I.V., Khokhlova I.D., Dzhibladze T.A.
Abstract

Ectopic pregnancy is the most common cause of emergency conditions in gynecology. The main clinical manifestations of ectopic pregnancy, in the background of signs of pregnancy, are the menstrual irregularities, delayed menstruation, spotting (the most classic clinical picture), pain syndrome (with and without irradiation to the rectum, thigh) of varying intensity (depending on the type of the ectopic pregnancy), signs of intra-abdominal bleeding. The key to successful treatment is timely diagnosis and qualified, adequate medical care. The main laboratory and instrumental methods for diagnosing the ectopic pregnancy are the determination of the β-subunit of hCG in blood serum (diagnostic accuracy of 85%) and ultrasound (diagnostic accuracy of 78–100%). The treatment of ectopic pregnancy is surgical, the laparoscopic access is preferred. Laparotomy access is indicated for severe adhesions, hemorrhagic shock caused by significant intraperitoneal bleeding. The surgical intervention during tubal pregnancy is tubectomy. Tubotomy (retention of the fallopian tube) is irrational, since the operated fallopian tube causes a recurrence of tubal pregnancy.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):4-9
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Literature reviews
The effect of combined oral contraceptives and hormone therapy during assisted reproductive technologies on the function of the hemostatic system in non-pregnant and pregnant women
Kirakosyan E.V., Sosnova E.A.
Abstract

A review of 130 sources of world literature was conducted in the databases Scopus, Web of Science, MedLine, Cochrane CENTRAL, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), EMBASE, Global Health, CyberLeninka, RSCI on the problem of the effect of combined oral contraceptives and hormone therapy during assisted reproductive technologies on the function of the hemostatic system in non-pregnant and pregnant women. In this review, we have summarized and analyzed information on the effect of sex hormones entering the woman’s body from the outside on individual links and the hemostatic system as a whole, determined the relationship between drug administration and thrombotic complications, optimized the sequence of diagnosis of conditions predisposing to thrombosis, substantiated the tactics of preparation and management patients taking exogenous hormones before and during pregnancy, including through in vitro fertilization.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):10-18
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Preeclampsia: definition, new in pathogenesis, guidelines, treatment and prevention
Kaptilnyy V.A., Reyshtat D.Y.
Abstract

The review reflects current views on the diagnosis, etiology, classification, pathogenesis and methods of treatment and prevention of preeclampsia. Theories of pathogenesis are described in detail, methodical recommendations are given. Comparisons of guidelines of international societies, their goals and methods of treatment of preeclampsia are presented.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):19-30
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Modern approaches to the diagnosis of gestational diabetes mellitus
Torosyan A.O., Gagayev C.G., Radzinskiy V.E.
Abstract

In a review there is provided information on modern approaches to the diagnosis of gestational diabetes mellitus. The use of various markers and screening methods and their role in pregnancy outcomes for the mother and fetus according to gestation of diagnosis are examined. The data obtained demonstrate that gestational diabetes, detected in early pregnancy, represents a special group of high risk of adverse outcomes and requires focused approaches in management.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):31-36
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Modern accents in the diagnostics of inflammatory diseases of the pelvic organs
Selikhova M.S., Soltys P.A.
Abstract

The clinical course of inflammatory diseases of the pelvic organs (PID) is very diverse, certain difficulties in the diagnosis of acute inflammation can be caused with a sufficient combination of probable symptoms. Most of the patients are subacute or chronic course of the disease. Not timely diagnosis and incorrectly prescribed treatment favorably affects the movement of the inflammatory process in the upper genital tract.

The diagnosis of PID in emergency rooms and clinics is often based on clinical criteria, with or without additional laboratory and visual tests. Clinical data have a sensitivity of 87% and a specificity of 50% versus 83% sensitivity and 26% specificity of endometrial culture.

The presence of leukocytosis in peripheral blood, elevated ESR and/or the level of C-reactive protein are also markers of inflammation and may be an indicator of the severity of the disease, but they do not serve as specific signs of PID.

The frequency of occurrence of inflammatory diseases of the reproductive system and common complications can lead to a pronounced imbalance in the reproductive potential of not only women, but also the population. The presence of a predominance of the chronic course of the disease, specialists of different profiles should have a sense of suspicion of the probable presence of an infectious agent in the pelvic organs in women of reproductive age in the presence of various non-specific complaints from the lower abdomen and the absence of other obvious reasons.

Untimely treatment of PID is closely associated with the deterioration of the patient’s condition and long-term complications.

To achieve successful attempts to prevent complications of PID, it is practically not possible, despite numerous studies.

The widely used routine laboratory examination methods have diagnostic value only in patients with pronounced symptom complexes, while in the chronic course their significance is small.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):37-42
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Original papers
Possibilities of using the SMARTXIDE2 V2LR laser system after reconstructive plastic surgery with use mesh prostheses for genital prolapse
Shul’china I.V., Ishchenko A.I., Ishchenko A.A., Gilyadova A.V.
Abstract

Introduction. Prolapse of pelvic organs is a polyetiological disease, manifested by a displacement of the uterus and he vaginal walls to the genital slit and/or by going beyond it. The urgency of the problem of prolapse of pelvic organ is associated with a tendency for an increase of morbidity in both elderly women due to increased expectancy of life and women of the reproductive period.

Material and methods. The study included 62 patients, age of them was 42–75 years. All women were underwent surgical correction with a transvaginal installation of the front mesh implant Gineflex with intraoperative extraction of fragments of the mucous membrane of the anterior wall of vagina with subsequent histological examination, as well as fragments of the mesh prosthesis after its installation and processing of the vaginal mucosa of the SmartXide2 V2LR laser system. Patients were separated on the two group taking into account the operating mode parameters of the fractional CO2 laser. In the 1st group, with a total laser energy of exposure 8.13 J/cm2, included 32 patients, in the 2nd, with a total laser energy of impact 1.48 J/cm2, — 30 patients. Transvaginal installation of the anterior mesh prosthesis Gineflex was complemented such the surgical interventions as extraperitoneal ligature hysterosuspension, posterior colporography, colpoperineoplasty, installation of “Urosling”, Manchester operation, supravaginal uterine amputation, adnexectomy in depending on the accompanied pathology.

Results. In the patients were determined II–IV stages of genital prolapse with using the POP-Q assessment system. During histological examination of a sample of biopsy of the vaginal mucosa, the thickness of walls ranged from 155 to 628 μm. During microscopy on fragments of mesh prostheses in the 1st group, fragmentary destruction of the fibers of all formed was noted, which not have been detected in the examination of a samples of patients of the 2nd group, where the total laser energy was less on 6.65 J/m2.

Conclusion. In patients with surgical correction of genital prolapse with using of a mesh implant upon the using the certain characteristics of SmartXide2 V2LR laser system for the exposure of the vaginal mucosa occurs partial destruction of the fibers of the mesh prosthesis, which allows to reduce the degree of tissue tension and consequently allows to reduce the level of complications after surgical diseases is associated with implantation a mesh prosthesis that does not reduce the effectiveness of this surgical treatment. This technique is safe, has no restrictions on the age and somatic status of patients, increases the tolerance of the postoperative period of surgical correction.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):43-46
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Features of the course of pregnancy at the preeclampsia of varying severity at the present stage
Simanov I.V.
Abstract

Objective — to study features of a course of pregnancy at a preeclampsia of varying severity and to compare them with data of control group of a research for the last 5 years.

Material and methods. 440 patients of fertile age with a preeclampsia of varying severity are inspected. 200 patients of similar age without preeclampsia made control group.

Findings. Data of the conducted research showed that the number of patients with toxicosis of the pregnant woman, threat of abortion and an iron deficiency anemia was statistically significantly 2–3 times more in the main group, than in control. In the second half of pregnancy at every fourth patient with a moderate preeclampsia and at every second from heavy the threat of premature births was observed. In the analysis of data the number of patients with threat of premature births in the main group was statistically significant in 3–5 times more, than in control, values of this complication varied from 25,2% (a moderate preeclampsia) to 50,8% (heavy). Premature amotio of normally located placenta took place at 6 of 63 patients with a heavy preeclampsia against the background of high figures of arterial pressure and heavy anemia.

Conclusion. Early diagnostics and treatment of complications of pregnancy at a preeclampsia will allow to improve the forecast for the forthcoming childbirth.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):47-52
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Clinical observations
Clinical case of delivery of a pregnant woman with vasa previa
Shevtsova E.P., Linchenko N.A.
Abstract

Anomalies of the umbilical cord are manifold and pose the greatest danger during the development of labor. Sheath attachment of the umbilical cord is one of the common causes of presentation of umbilical cord vessels. Vasa previa (VP) causes diagnostic difficulties, cannot be corrected during pregnancy and does not affect the birth process, but is characterized by a high frequency of perinatal mortality. This observation demonstrates the need for close attention of obstetrician-gynecologists and ultrasound doctors to such a rare condition as VP. The article discusses the clinical case of successful delivery of a pregnant woman with this pathology.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2020;7(1):53-56
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