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Vol 5, No 1 (2018)

Original papers
BLOOD VOLUME AND HEMODYNAMIC CHANGES IN PREGNANTS, PARTURIENTS AND PUERPERAE
Ronenson A.M., Shifman E.M., Kulikov A.V.
Abstract
In the article, there are considered questions of physiological changes of the blood volume status during pregnancy, parturition and in the postpartum period, features of functional and structural changes of the cardiovascular system. The determination of the circulating blood volume is still a stumbling block for obstetrician-gynecologists and anesthesiologists-resuscitators. Our view of the normal blood volume status during pregnancy is important in light of the assessment of the blood loss in the development of massive obstetric hemorrhage. The doctor needs to know what changes in the cardiovascular system are physiological and which are pathological in case of blood loss, with taking into account the functional changes in the heart that occur during pregnancy, parturition and in the earliest postpartum period. A deeper understanding of this problem will help the doctor avoid aggressive infusion therapy, which can lead to complications.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):4-8
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HEMOSTASIOLOGICAL INDICES IN PREGNANT WOMEN WITH ARTERIAL HYPERTENSION AND INTRAUTERINE GROWTH RESTRICTION (IUGR)
Murashko A.V., Simonova M.S., Goryunova A.G.
Abstract
The article analyzes the results of the management of patients with preeclampsia, intrauterine growth retardation syndrome, and disorders of the hemostatic system during pregnancy. With the help of thromboelastography, the state of all the components of the coagulation system including plasma component of blood, platelet hemostasis, and fibrinolysis system was assessed, the efficacy of drugs (anticoagulants) prescribed patients and the adequacy of the selected dosage was checked. Assessing presented clinical observations, we can conclude that it is necessary to conduct thromboelastography in pregnant women. Conducting a functional test with heparinase extends the diagnostic significance of thromboelastography.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):9-11
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MULTILEVEL SURGICAL CORRECTION OF POSTGISTERECTOMIC GENITAL HERNIA
Ishchenko A.I., Aleksandrov L.S., Ishchenko A.A., Gorbenko O.Y., Khokhlova I.D., Gavrilova T.V., Gadaeva I.V., Tarasenko Y.N.
Abstract
The article presents a new surgical method for correcting posthisterectomic genital hernia, accompanied by bilateral paravaginal defects. Despite the use of many surgical techniques and high-tech materials for the prevention and treatment of posthisterectomic genital hernia, the prevalence rate of this pathology fails to decline, but on the contrary, for many reasons, it tends to grow, which calls for the development of new surgical methods of the treatment. The proposed surgical program of multilevel correction of posthisterectomic genital hernia with bilateral paravaginal defects, providing multifocal fixation of anatomical structures with polypropylene implants, will improve clinical results and their duration, as well as the fall of the prevalence rate of relapses of the disease.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):12-18
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MORPHOLOGICAL AND MOLECULAR CRITERIA OF THE ENDOMETRIAL RECIPTIVITY VIOLATION IN PATIENTS WITH INFERTILITY ASSOCIATED WITH CHRONIC ENDOMETRITIS
Demura T.A., Kogan E.A., Kossovich Y.M., Unanyan A.L.
Abstract
The goal is to study the morphological and molecular features of endometrial receptivity in reproductive-age women with chronic endometritis and infertility and unsuccessful attempts in vitro fertilization (IVF) in anamnesis. Material and methods. The study included 120 reproductive-age women with morphologically verified chronic endometritis: the first group included 64 patients with infertility and unsuccessful IVF attempts in history; in the 2nd group there were 56 women without violation of the fertility; the control group consisted of 30 healthy reproductive-age women, in whom samples of the endometrium were taken in the II phase of the menstrual cycle. A comparative analysis of the morphological and molecular criteria of endometrial receptivity in all study groups was carried out. Results. In patients of the 1st group there was a significant twofold prevalence rate of the average duration of chronic endometritis since the moment of its morphological verification, which led to a critical decrease in the receptivity of the endometrium and the development of infertility has been established in 5.50 ± 0.06 years (p < 0.001). In the first group of patients following morphological features of chronic endometritis were established: the presence of classical signs of inflammation in the mucous membrane of the uterus with an autoimmune component revealed in 90.6% of observations: high expression of CD16, CD20, CD56 and low HLA-DRII (p < 0.001). Morphological criteria of endometrial receptivity disorders in patients with infertility on the background of chronic endometritis were such as the delay in the maturation of the endometrium from the day of the menstrual cycle and a decrease in the number of mature pinopodia in the apical part of the superficial epitheliocytes. Molecular criteria of the infertility in the endometrial receptivity violation include the significant decrease in the expression of steroid ER and PR receptors in glands and stroma, LIF in glands and in the surface of the pinopodia, CLDN4 - in the apical part of the superficial epithelial cells and in the base of the pinopodia (p < 0.001). Conclusion. Chronic endometritis, associated with the infertility, in 90.6% of cases has an autoimmune genesis and is characterized by a long (more than 5 years) course with the development of morphological and molecular criteria of endometrial receptivity disorders.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):19-25
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STRUCTURE OF INFECTIOUS SCREENING OF PREGNANTS: RUSSIAN AND OVERALL PRACTICE
Naumenko N.S., Nikonov A.P., Astsaturova O.R., Belova A.V.
Abstract
Infectious diseases are still one of the main causes of perinatal losses worldwide. The consequences for the fetus and the newborn vary from asymptomatic infection to sepsis, malformations and the fetal death. Examination of pregnant women for the presence of infectious agents is an important part of the antenatal care program. The purpose of the work was to assess the structure of infectious screening in various medical institutions in Moscow, as well as the comparison of the recommended in Russia examinations with the main programs of antenatal monitoring in the world. Material and methods. The retrospective study was executed on the basis of four medical institutions: two state women’s clinics and two commercial clinics (the total number of patients - 902 people). The comparison was made with antenatal care programs of the antenatal observation in Centers for Disease Control and Prevention (CDC), 2015 (Centers for Disease Control and Prevention) in the United States of America, and the National Institute for Health and Care Excellence (NICE), 2017 (National Institute for Health and Medical Quality assistance), Great Britain. Results. Basic screening of pregnant women for infection in the Russian Federation includes 8 items (serological study of the blood for syphilis, HIV, hepatitis B and C, rubella, toxoplasmosis, microscopic examination of genital secretions on Neisseria gonorrhoeae and fungi of the genus Candida), which is significantly higher than in the USA and Great Britain (5 and 4 respectively). According to the results of our study, the volume of the compulsory examination of pregnant women is wider than abroad, due to serological examination of blood for the presence of antibodies to cytomegalovirus (CMV) and herpes simplex virus (HSV) of types 1 and 2, microbiological examination of genital secretions, molecular biological diagnosis (polymerase chain reaction - PCR, real-time PCR). Conclusion. Screening of pregnant women for infection in public and commercial clinics has a number of differences. The actual scope of the survey is higher than recommended by the state. The Russian list of tests in comparison with foreign analogs is much wider in terms of the number of nosologies and the frequency of the research. It is necessary to conduct multicenter epidemiological studies throughout the Russian Federation to create optimal regional programs for examining pregnant women for infection that meet the criteria for effective screening.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):26-30
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ENDOMETRIOSIS AND INFERTILITY. OPERATION OR ASSISTED REPRODUCTIVE TECHNOLOGIES?
Kuzmina N.S., Bezhenar V.F., Kalugina A.S.
Abstract
The aim of the study was to study the influence of the ovarian endometrioma on the ovarian reserve, the ovarian response in ovarian hyperstimulation, and outcomes of assisted reproductive technologies (ART). Material and methods. The study included 43 infertility patients underwent the surgical treatment of an ovarian endometrioma in the history. During the study, the follicles were counted separately (according to transvaginal ultrasound), eggs and embryos were obtained from the operated and intact ovaries. Results. The number of follicles in the ovary, operated due to endometriosis, is significantly lower than in the contralateral ovary (p = 0.005). The number of ovules punctured from the ovary, operated for endometriosis, is less than the number of ovules obtained from the intact ovary, but the difference does not reach statistical significance (p = 0.07). The number of high-quality embryos obtained from the ovary, operated for endometrioma, is statistically significantly lower than the number of similar embryos obtained from the intact ovary (p = 0.013). Conclusion. According to the conducted study, it can be concluded that the surgical treatment of endometrioma in infertility patients with the need for the implementation of the reproductive function reduces the number of follicles in the operated ovary and, accordingly, does not lead to an improvement in indices of the infertility treatment using ART. At the same time, the very presence of endometrioma is also known to negatively impact on outcomes of ART. Therefore, in infertility patients with the reduced ovarian reserve, individualization of approaches to treatment is extremely important.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):31-36
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BLEEDINGS IN THE HIGH-RISK GROUP OBSTETRIC HOSPITAL
Guseva E.M.
Abstract
Massive hemorrhage and hemorrhagic shock as main causes of deaths in pregnancy, occupy up to 25% in the structure of mortality rate in obstetrics. In the past decade, the decline in the share of deaths of mothers has occurred due to postpartum bleedings and bleedings in detachment or placenta previa. The aim of the study was to determine the frequency and structure of massive bleedings in a high-risk group obstetric hospital. Methods. A retrospective descriptive cohort study was executed in 2 stages: at the 1st stage - a study of 396 deliveries histories with main nosological forms leading to possible pathological hemorrhage, in the II stage - analysis of 55 cases of massive blood loss. The object of the study was puerperas with placenta previa; puerperas with deliveries complicated by hypotonic bleeding or premature detachment of the placenta; puerperas with the massive blood loss. Duration of the study: from 01.01.2011 to 31.12. 2015. Results. The most frequent nosological form leading to abnormal blood loss is premature placental abruption. The frequency of cases of massive blood loss (more than 1000 ml) is 0.28% of the total number of deliveries and is more common in primigravidae (56.4%), mainly during surgical delivery (88%). Out of all massive bleedings, 45.5% are due to uterine hypotension. Amputation of the uterus was performed in 18.2% of the number of all cases of the massive hemorrhage. Conclusion. The high prevalence rate of the premature detachment of the placenta is explained by the uncontrollability of this pathology, in contrast to hypotonic bleeding in the postpartum period. The organ-preserving management in massive obstetric hemorrhages is not widely used.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):37-40
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ANALYSIS OF PERIOPERATIVE PRESCRIBING OF ANTIMICROBIAL CHEMICAL IN CESAREAN SECTION
Korobkov N.A., Tekhova I.G.
Abstract
The executed pharmacoepidemiological study aimed at assessing stereotypes of perioperative antimicrobial prophylaxis in abdominal delivery in maternity hospitals of the city of St. Petersburg showed that more than in 30% of cases there was an inefficient use of antimicrobial chemotherapy drugs, which in turn contributes to the increase in the frequency of postoperative septic complications.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):41-44
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OBSTETRIC AUDIT BASED ON ROBSON TEN-GROUP CLASSIFICATION SYSTEM
Miroshnikov A.E., Zharkin N.A.
Abstract
The problem of the increase in the frequency of Cesarean section delivery has not been resolved yet. Firstly, a large variation in the initial state of puerpera, secondly, a wide variety of indications to the operation fail to allow revealing main determinants. In order to develop and implement effective measures to reduce the rate of the abdominal delivery, an understandable, logical classification of patients is necessary. The World Health Organization recommends the use of Robson Ten-Group Classification System. This study executed with the use of the Robson scale reveals the contingent of patients in whom the decline in the frequency of abdominal deliveries is possible. The authors propose a set of measures aimed at reducing the rate of Cesarean section in institutions of the second level.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):45-48
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TACTICS OF THE MANAGEMENT OF PREMATURE DELIVERIES: TO WHAT PATIENTS TOCOLYSIS IS INDICATED AND SHOULD HELP
Ignatko I.V., Shvyreva E.A., Lebedev V.A., Churganova A.A., Bogacheva N.A., Sorokina V.M.
Abstract
The urgency of the problem of premature birth (PB) is caused due to a high early neonatal mortality rate among preterm infants (60-70%), the prevalence rate of neurologic diseases (up to 50%), including infantile cerebral palsy, visual, hearing disorders and other chronic diseases. The frequency of PB in the population varies between 7 and 15%, however, despite the great possibilities of modern midwifery, there is a pronounced tendency to increase this index. The analysis of the lethality of prematurity in perinatal centers of the Department of Healthcare of the city of Moscow in 2016, obviously shows the main part of it to be presented by with extremely low body weight infants. Thus, preventing the premature birth, especially at the term of 24-27 weeks, is an important task for medicine all over the world. Atosiban (tractocile) - a competitive antagonist of human oxytocin at the level of receptors, the first drug designed to inhibit labor. For the purpose of tocolysis 54 women at the 26-34 weeks of the gestation period got the treatment with tractocile. Tocolysis with atosiban was effective in 90.7% of cases with a slight shortening of the cervix (no more than 5 mm) regardless of the gestational age. The introduction of the drug leads to a decrease in the intensity and jugulating pain syndrome in the first 6 hours following the administration, which confirms its effectiveness and allows increase chances of a favorable outcome of pregnancy. The absence of the infection of the kidneys and urinary tracts during pregnancy and genital tract, the onset of tocolysis up to the 31st week of the gestation and the absence of ischemic-cervical insufficiency, which indicates the need for quality and rational management of pregnancy at the outpatient stage are most important factors for the success of tocolysis and prolongation of pregnancy for more than 48 hours.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(1):49-54
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