Vol 49, No 4 (2000)

The present article deals -with contemporary situation in urogynecology and touches upon the issues of structure of morbidity with urogenital diseases, medical and social aspects of the problem, and measures that should be undertaken.

Peculiarities of urogenital microflora were studied in 75 pregnant and 4 7 non - pregnant patients with urethritis. Women with urethritis usually demonstrate normal (physiological) vaginal biocenosis, which corresponds to the 1^st degree. The 2^nd degree, indicating bacterial vaginosis, is revealed significantly more оf ten in non-pregnant than in pregnant women. Monoinfection more often takes place in pregnant women, while combined infection in non-pregnant patients. The leading role in the development of urethritis in pregnant and non-pregnant women belongs to ureaplasms, enterobacteria, Mycoplasma hominis, Cory nebacterium urealyticum, Candida sp., Chlamydia trachomatis, group В streptococci.

The results of treatment of 20 women with vesico-vaginal fistula were generalized. The fistulae appeared after operations in connection with genital endometriosis. Genital endometriosis turned out to promote the development of fistulae due to its fermentative activity after gynecological operations. Postoperative treatment of patients of this category implies complex therapy оf genital endometriosis with subsequent fistula plastics.

The article considers the problem of ureter injury in the course of obstetric- gynecologic invasion. The authors pay attention to the symptoms, which make possible to diagnose the pathology, to complications, prophylactic measures of preventing ureter injury, methods of its treatment.

Ultrasound scanning о f urethral canal and urinary bladder in 25 women with urethritis was performed. Urethral length, diameter and form, the presence of cystourethral funnel, residual urine was determined. Various forms of urethra under urethritis were observed. The differences in urethral length don’t go beyond the limits of physiological fluctuations.

After having held urodynamic examination of 700 women complaining of stress-incontinence 292 cases of bladder instability were revealed. Bladder instability is characterized by spontaneous or provoked detrusor reactions of hypertensive type. They appear involuntarily and are followed with simultaneous urethra relaxation. Heavy increase of intravesical pressure along with the decrease of obturative one under physical stress may lead to urine loss in case of abnormal transmission of increased intraperitoneal pressure impulse. Forming of functional cystourethral funnel and relaxation of urethral cross-striated sphincter cause these disturbances. Bladder instability may lead to the development of stress incontinence or complicate its running.

With the use of immunoferment method the level of estradiol and progesterone in 78 women with single and 39 women with double pregnancy developing after extracorporal fertilization (ECF) was examined. In case of normal single pregnancy after ECF estradiol and progesterone content corresponds to the indices of control group during the whole period of gestation. Under single pregnancy complicated by threat of abortion low estradiol and progesterone level indicates insufficiency of the yellow body and placenta. Predominance of estrogenic influence turns out to be the decisive factor of late abortion and preterm delivery in pregnant women of this group. Under the threat of abortion in the 1^st term of double pregnancy progesterone level is certain to decrease. The results of the study give proof of the necessity of individual approach to the therapy of abortion threat in cases of single and double pregnancy after ECF.

The data on cardiovascular system pathology in context of women’s reproductive system state are analyzed. An important role of climacteric period as a supplementary “female” risk factor in development of cardiovascular diseases is revealed. The differences in morbidity structure in case of physiological and surgical menopause are established. The state of cardiovascular system in patients subjected to substitutive hormonotherapy is examined.

The article considers the mechanisms of early gestational development, the causes of spontaneous abortion, different approaches to its treatment and prophylaxis. It also carries information on modem preparations applied to support early pregnancy.

In the present article the review of modem literature on questions of physiology, biochemistry and the main aspects of use of erythropoietin is presented. Since 1985DNA-recombinant human erythropoietin (rhEPO), which is applied for the replacement therapy in patients with insufficient production of EPO, became accessible. Since 1997 the Russian preparation rhEPO «Epocrin» is permitted for clinical application. RhEPO in combination with adequate organism saturation with iron is noticed to stimulate erythropoesis effectively inpatients with anemia including pregnant women, postpartum women and premature infants as well.

To determine the role of cytokines in pathogenesis of pre-eclampsia, production of IL1/3, IL4, IL6 and TNFa by chorionic villous explant of healthy women and patients with pre-eclampsia under the influence of hypoxia was investigated. The results received testify to considerable changes of cytokine production connected with the form of pre-eclampsia. So, placenta as a source of cytokines in case of pre-eclampsia appears to injure endothelium.

"Only ignorance and inhumanity can dare to mutilate a living baby in order to avoid a Caesarian section. Nothing can justify an obstetrician." J.L. Beaudolet, 1781.