Vol 1, No 1 (2014)

Nephrological manifestations of “early” and “late” pre-eclampsia (PE) are described. Clinical manifestations are analyzed with consideration for the placental angiogenesis markers: VEGF and sFlt-1. Women with early PE (gestation age Me32 [29; 34] weeks) had higher systolic and diastolic BP (170 ± 16.8 vs. 156 ± 6.56 mm Hg and 105 ± 8.9 vs. 99 ± 6.9 mm Hg, respectively), 4-fold higher incidence of renal dysfunction, presented by low glomerular filtration rate (GFR; Me 70 [51; 80] ml/min) and/or high serum creatinin levels (Me 90 [78; 102] мmol/liter), 7-fold higher incidence of the nephrotic syndrome, and 3-fold higher level of sFlt-1 than patients with late PE (gestation age Me 38 [36; 39] weeks). Inverse correlation between GFR and sFlt-1 (r = -0.42; p = 0.050) and direct correlation between GFR and VEGF (r = 0.47; p = 0.038) were detected in PE patients. The contribution of angiogenesis placental markers imbalance to the formation of proteinuria, arterial hypertension, and renal dysfunction in PE and the contribution of thrombophilia to PE development are discussed.

Elevate transvaginal system was used for surgical correction of the pelvic floor defects in 156 patients with the pelvic organ prolapse. Intraoperative blood loss of more than 500 ml was recorded in 15 (9.4%) patients. Two cases with negligible (no more than 10-15 mm 3) hematomas of Retzius ’ space and paraurethral zone were recorded. No complications, such as vaginal erosion, extrusion of mesh implant, painful syndrome, dyspareunia were recorded over the period of observation. No intraoperative complications were recorded. Three (1.9%) patients developed relapses (elongation of the uterine cervix and cervix stump). The long-term (3 years) anatomic (objective) efficiency of pelvic organ prolapse correction in our study reached 92.1%. The functional efficiency of Elevate transvaginal system anterior was 94.6%. The results indicated that in cases with the cervix uteri or cervix uteri stump elongation they were to be resected or amputated when implanting the Elevate anterior system.

Aromatase expression in endometrioid heterotopies was studied. The results served as pathogenetic validation of using aromatase inhibitors in combined therapy for genital endometriosis. Aromatase inhibitors were used in the treatment of endometriosis patients. The efficiency of sterility control and painful syndrome arrest were evaluated and the side effects of therapy were characterized.

Obstetrical peritonitis is the most severe septic complication of cesarean section, which can eventuate in maternal death. Its incidence varies from 0.05 to 1.5% all over the world. Surgical strategy in this condition includes 1) extirpation of the uterus as a source of infection and 2) resection of necrotic tissues on the uterus with subsequent metroplasty. The conditions for, indications for, and contraindications precluding organ-sparing surgical treatment of puerperae with incompetent sutures on the uterus after cesarean section in the presence of peritonitis are presented. The authors emphasize that sepsis is the main contraindication precluding metroplasty.

Echography is an important instrument for the diagnosis of diabetic fetopathy. Detection of the specific symptom complex of the endocrinopathy, including evaluation of the proportional size of the fetus and visceral signs, promotes detection ofpregnancy complications sometimes before the clinical diagnosis of gestation diabetes mellitus. Ultrasonic findings can serve as the criteria for starting insulin therapy and evaluating its efficiency.