Vol 5, No 2 (2018)

The review provides information on the clinical and physiological features of the functioning of the hepatobiliary system in women during a normally developing pregnancy. The causes and magnitude of changes in specific blood biochemical indices in pregnant women are analyzed. An analysis of various liver pathologies in pregnant women associated with the administration of frequently prescribed medications is also presented.

In the article, there are analyzed main pathogenetic aspects of the relationship between antiphospholipid syndrome (APS) and reproductive losses, obstetric pathology, as well as possible methods for improving pathogenetic prophylaxis of repeated failures of in vitro fertilization (IVF). Based on the literature data, there is made a conclusion about the need for further studies of the role of antiphospholipid antibodies (AFA) as a cause of IVF failures, as well as the search for the most effective methods of preventing repeated failures of this procedure in a group of women with APS.

Introduction. Prolapse of pelvic organs is a polyethological disease, manifested by the displacement of the uterus and the walls of the vagina to the vulvar ring or out of it. At the base of this pathology, there is the functional inconsistency of the ligament apparatus of internal genital organs and pelvic floor musclesoccurring due to the impact of various physical, genetic, psychological, age, hormonal, iatrogenic etiological factors. Prolapse of the pelvic organs is an actual problem due to the high incidence of both reproductive and elderly women. This article considers the effectiveness of criteria for selection patients with different degrees of prolapse of the genitals for the implementation of surgical correction in conditions of the gynecological department of the municipal maternity hospital. Material and methods. The sample included patients with initial, post-hysterectomic, recurrent anterior and apical prolapse of the genitalia of II-IV degree according to POP-Q classification in the age cohort of 45-70 years who do not have systemic diseases, or with a compensated systemic disease that does not introduce significant limitations in physical and social activity. Depending on the severity of pelvic prolapse, patients underwent various types of surgical treatment. In 5 patients with incomplete uterine prolapse, there was performed laparoscopic extraperitoneal ligature hysterosuspension and vaginal wall plasty using reticular implants, and in the 1 patient with the complete prolapse of the uterus, there was made the vaginal extirpation of the uterus with extraperitoneal colposuspension vaginal walls plasty using a reticular implant. Women with adjacent gynecological pathology (24 patients) underwent laparoscopic (22) and laparotomic (2) operations for the main disease and the plasty of the vaginal walls (including 19 patients using reticular implants). In one case, a patient with elongation of the cervix and the lowering of the anterior wall of the vagina there was performed a modification of the Manchester operation using a reticular implant. In 3 patients with the isolated prolapse of the anterior wall of the vagina, the vaginal wall plasty was made with the installation of a reticular implant. Results. After the surgical interventions, no intraoperative, as well as early or late postoperative complications were noted. The evaluation of the effectiveness of the performed surgical treatment according to follow up in the period of from 12 months to 5 years, revealed 1 case of the recurrence of the disease in the form of cervical stump prolapse in a 58-year-old patient managed with succeed promonofixation of the cervical stump with a reticular implant. Conclusion. The high anatomical (94.4%) and functional (96.8%) efficacy of the surgical treatment of the prolapse of pelvic organs allow judging the persuasiveness of selection criteria for surgical correction of the genital prolapse in conditions of the gynecological department of the maternity hospital.

Vaginal hysterectomy seems to be the optimal access, but this method does not take a worthy place in operative gynecology. In this study, a prospective comparison of 2 different techniques of vaginal hysterectomy was performed in 125 patients with the use of vicryl ligatures and 215 patients using bipolar coagulation devices (Gyrus and Emed) in different clinics. In the analysis of immediate and remote results, in the group with electrosurgery, blood loss, operation time and pain syndrome at 4 and 48 hours were found to be statistically significantly less. Also, we did not discern any differences in the number of postoperative complications, which allows us to make conclusions regarding the safety and effectiveness of the use of modern bipolar coagulation devices by experienced surgeons.

The article reflects a modern view on the introduction of fluorescent methods of diagnostics and treatment of vaginal infections using lactoferrin in clinical microbiology, which made it possible to expand microecological studies. The suppression of the normal vaginal microflora was shown to promote a diverse pathology of both inflammatory and non-inflammatory genesis. Bacterial and fungal vaginosis were proved to be the most important risk factors for the development of infectious complications in the gynecological practice. There are given substantiated scientific evidence, indicating a large number of recurrences of bacterial and candidal vaginitis, despite the numerous studies and various treatment options. The relationship of bacterial vaginitis with infertility, the threat of miscarriage, premature birth, intrauterine infection of the fetus, etc. was established. Based on this, the search for alternative combined methods is relevant. The aim of the study was to increase the effectiveness of the treatment of recurrent candid vulvovaginitis and bacterial vaginosis by using lactoferrin. In the study, there were used fluorescent methods of the diagnosis, which made it possible to verify the diagnosis in the rapid assessment mode, as well as monitor treatment and improve its effectiveness.