Vol 48, No 2 (1999)

The problem of infectious-inflammatory complications during pregnancy, in labor and in postpartum period is a priority direction in obstetrical practice. For the decision of the given task the complex examination of 111 women was carried out during pregnancy, in labor and in postpartum period. The study of vaginal microecology included a complex estimation of cultural diagnostics results and vaginal smears microscopy, Gram-painted. The carried out research shows, that duly diagnostics and disbiotic vaginal processes correction in pregnant group of risk will allow to lower a number of complications during pregnancy, in labor and postpartum period.

Pelvic inflammatory diseases are widespread form of women pathology. In many cases these diseases are connected to IUD application and frequently result in violations of specific functions of a female organism. We conduct operation on generalization of data of literary sources, with reference to the given kind of a pathology, analyse the etiology, clinical features, methods of treatment (conservative and surgical), and also paths for restoring fertility and endocrine functions.

The experience of caudal epidural application anestesia is submitted for operations in gynecologic patients. The hypoosmolal anestethic solution (osmolality 260 Mosm/kgs) is used, prepared on the basis of the solution, concentrated 10 %, lidocaine, 0,9 % sodium chloride solution and distillated water. The caudal epidural anestesia application during operations allowed to ensure reliable protection against a surgical trauma, not rendering adverse influence on systems of breath and blood circulation. The analgetic effect duration made 3±0,5 hours, at sedative drugs potentiation it was increased even more. Complications of a used technique are not marked. Simplicity and, safety of a technique allow to recommend it to wide practical use.

The clinical effectiveness of the implimintation of the Prostaglandin's E2 and F2a for labor preparation, for induction and regulation of the childbirth process was studied. Prepidil gel was applied for cervix preparation for labor by various testimony in 142 patients. The maturing of the cervix was note in 50,3% patients, and the effect of stimulation of labor was reach in 46,5% patients. Prostin E2 and F2a were used in case of PPROM and for treatment of the dystocia in 53 patients. The clinical analysis of the labors was performed. It was discovered, that Prostaglandin's have high effectiveness for cervix preparation in labor, for stimulation of childbirth process and labor induction, for the prevention of long pregnancy.

Central hemodynamics was tested by rheographyc method by Kubichek at 169 women at term of 27-34 weeks of pregnancy with IDD and gestosis of a mild degree, with gestosis without infringements of a carbohydrate exchange and practically healthy. There are the essential changes of the central hemodynamics are revealed at the mild forms of gestosis: frequency of cardiac reductions, diastolic and average hemodynamics pressure, systemic peripheric resistance were higher, and the parameters of work of heart - stroke output, shock index, volumetric rate of emission and capacity of a left ventricle - are lower, than appropriate parameters of the healthy pregnant women. At a nephropathy-I is shown, that the infringements of a vascular link of a hemodynamics increases at conservation of changes cardiodynamics, having a place at edemas in pregnant women. At pregnant woman with IDD and gestosis an infringement of a hemodynamics deeper, than at pregnant with gestosis without diabetes. These infringements are shown by aggravation of a heart failure and vascular complications, even at the mild forms of late gestosis.

In this work we have studied the changes of decidua in premature labor and analysed the pregnancy, labor, postnatal period and neonatal period in women with infection of decidua. We have obtained existing of certain pathological changes of decidua in 98% of all cases of premature parturition. In this part there were 68% of cases with infectious disorders. And almost always (in 93%) they were accompanied by involutionary-dystrophic and dyscirculatory changes of decidua and disorders of ripening of villi. We have revealed an inflammation with the major forms of localization as damage of decidual membrane, choriodeciduitis, and intervillusitis without major localization under chorial lamina. We have also revealed damage of syncytium and stroma of villi with deposition of maternal leukocytes without involving of villous vessels in inflammatory process. This all is to confirm that the main sources infecting decidua are the foci of infection in pregnant women. Therefore, infectious agents from those foci spread into decidua by haematogenic ways.

In the article the basic statistical data about the myoma myometrium morbidity are set up. The consequences after radical operations concerning benign lesions of a uterus and adnex are described. The expediency of more broad organ-saving operations application is justified. The new tactics of myoma management is shown. The basic criteria are considered by selection of a method of treatment and definition of a operation volume, which are closely connected to the appeared modern methods of diagnostics. Here are described the most used in daily practice organ-saving methods of surgical treatment.

Infectious and inflammatory diseases of female genitals occupy a special place in structure of general morbidity on a planet. Their importance is caused first of all by the fact, that these illnesses involve organs and tissues concerning to reproductive system, and consequently have direct influence on reproductive function and continuation of a life in the world. In the first part of this clinical lecture ther are considered and are stated in details the modern aspects of a reproductive health problem.

The role of ischemic-duodenal insufficiency (IDI) in spontaneous termination of pregnancy has not been fully elucidated. The development of various modifications of the surgical treatment of IDI is of great importance, which has led to a very wide use of surgical interventions on the cervix, including "prophylactic" interventions. The application of a circular suture to the cervix is appropriate only in cases where there is an organic variant of this pathology. Differential diagnosis of organic and functional IDI in pregnancy is difficult.

«As to continue my 50-year period of work in medicine, I noted the way the medical science is developing in the fatherland. And as I have seen its quick development I could have hardly stay not amazed. For half-century before that we were only students and the followers of our leaders - foreign men, because we didn’t have any native leader in any of the medicine field. But now, thanks God...we are equal to their level and can do our way ourselves».

S.A. Gromov (1852)

The VII Congress of Obstetricians and Gynaecologists of the Baltic Sea Countries and the I Russian Seminar of the European Association of Perinatal Medicine were held in the concert hall of the St. Petersburg Hotel on May 12-15, 1999. The Congress was organized in collaboration with the International Scientific Committee of Obstetricians-Gynecologists of the Baltic Sea States, D. O. Ott Research Institute of Obstetrics and Gynecology of RAMS, Administrations of Saint Petersburg and Leningrad Region, Association of Obstetricians-Gynecologists of Saint Petersburg and Leningrad Region and Regional Public Organization of Health Care Support "Medelita". A significant role in the organization of the Congress belonged to the St. Petersburg firm "BIMK-Cardio", a recipient of the "Public Recognition of St. Petersburg" mark for 1997 and 1998.