Vol 51, No 2 (2002)

The modem literature review concerning diagnostic and cure tactics during observation of pregnancy and delivery in women with pelvic traumas and post- traumatic altering support-moving apparatus is presented in this article. The diagnostic tactics based on the accurate assess of clinical data and on analysis of laboratory and instrumental research methods have been substantiated for estimation of pregnant woman and fetus conditions with available pelvic injures. It allows make more exact prognosis, select criteria of pregnants for the conservative conduction; establish indices for the operational cure.

The results of the twelve-year work of the St. Petersburg Center for the Prevention and Treatment of Miscarriage (NB) have been summed up. During this time, 6755 women, 2856 pregnant women and 3899 non-pregnant women were observed at the Center. Women suffering from misdiagnosis received a comprehensive comprehensive examination, on the basis of which the prevention and treatment of NB was carried out. This made it possible for women with 1OO% loss of pregnancies in the past to achieve a decrease in the frequency of spontaneous abortions in 2OO1 to 7.6% and premature births to 2.7%.

The publication is dedicated to a new and one of the important branches of medicine - perinatology - a science that emerged at the intersection of obstetrics and pediatrics. Numerous studies in recent years have convincingly proven the leading role of the placenta in the functioning of the biological system "mother-placenta-fetus". At the same time, most expert assessments convincingly prove that the pathology of the placenta, including its insufficiency, in the structure of the causes of perinatal and child mortality exceeds 20%. It is also known that dysfunction of the placenta causes numerous changes in the child's body, which are the cause of violations of his physical and mental development.

The problem of protecting the health of mothers and children is the most important component of health care, which is of paramount importance for the formation of a healthy generation of people. Premature birth has a psycho-social aspect, since the birth of a handicapped child, his illness and death are severe mental trauma for the family.

Some disputable matters according to the problem of prematurely labor were presented in this article.

The urgency of the problem is due to the fact that preterm birth determines the level of perinatal mortality and morbidity. The management of labor is determined by the gestational age. Termination of pregnancy in the period of 22-27 weeks is most often due to infection and fetal malformations, determined by this period of gestation. With a gestational age of 28-33 weeks, the percentage of indicated premature births is extremely high due to a complicated course of pregnancy (preeclampsia, placental insufficiency) and severe extragenital diseases. Premature birth at 34-37 weeks is close to timely delivery in terms of labor outcomes.

The common loss of gestation is a poly etiological complication during pregnancy time, where together with causes and factors of embryo/fetus peril there are destructions of the conjugal reproductive system. Main disturbances due to aborts in early terms are cariotype breakages: chromosome translocations and inversions were revealed in 8, 8% of inspected conjugal pairs, “cariotype peculiarities” in 72, 7%, conjugal compatibility according to HL А тогеЗ antigens was detected in 59, 3%. Disturbances of trophoblast invasion processes and placenta formation are evident because of hormonal distortions (NLF, hyperandrogeny), autoimmune distortions and chronicle endometritis with high level of anti-inflammatory cytokines. The development of placenta insufficiency in patients with these disturbances leads to pregnancy interruption.

The pregnancy loss problem is topical for obstetrical practices nowadays. Last years investigations based on anaerobic bacteriology achievements have changed traditional aspects of these diseases microscopic etiology and in concordance with it on their diagnostics. The new data obtained assert disbiotical disturbances in vagina biological field in pregnancies have influenced on it. Representatives of conditional-pathogenic microscopic flora have the main etiologic significance in it.

The present work aim was studying the role of conditional-pathogenic microscopic flora in pregnancy loss.

The aim of the research was to investigate the pathomorphological changes in placentas of women with recurrent pregnancy losses under action of different injuring stimulus (infection, hormonal, biochemical reactions on membrans of syncytiotrophoblast and endothelium of placental vessels, actions of antiphospholipid antibodies). Identical changes was detected which connected with immune complexes (IC) formation. IC with different composition generate immunopathological processes in placental tissues. Present of antiphospholipid antibodies on placental membranes enhancing immunopathological processes, leading to dystrophic and necrotic lesions in surrounding tissues and to placental insufficiency. The outcome of this lesions is incompetent pregnancy.

Therefore IC may be the marker of placental injury and insufficiency as well as a biologic indicator of failure in reproductive system.

The treatment of threatened abortion is improve pregnancy outcomes and immunomorphological evidence.

The aim of the study was to evaluat`e the use of the drug duphaston: 1) to prepare for an upcoming pregnancy in women with hyperandrogenism and insufficiency of the luteal phase of the cycle; 2) to treat the threat of termination of pregnancy in women with a history of miscarriage.

The use of duphaston in women suffering from miscarriage has confirmed its high efficiency both in preparation for pregnancy in patients with hyperandrogenism and insufficiency of the luteal phase of the menstrual cycle, and in the treatment of threatened abortion. In 93.5% of women with a history of 100% fetal loss, it was possible to bring the pregnancy to delivery.

Pathology of respiratory system plays a significant role in morbidity and mortality of premature neonates and it means that searching of new and remodeling of existing methods to diagnose and treat respiratory insufficiency (RI) is of particular importance. We evaluated a new method of an early preclinical diagnosis of RI based on using of capnography — assessment of end- tidal CO2 concentration, which makes possible to propose a leading pathophysiological mechanism of RI. Using of the gradient between end-tidal and capillary CO2 concentrations helps to predict development of serious ventilation-perfusion mismatch when it exceeds 2O mm Hg. So, in the treatment of RI in neonates individualized therapy should be used, based on the assessment of the leading pathophysiological mechanism.

The article presents a review of new literature and own data resulted from a many-years study of inf ections in pregnant women. Pathogenesis and diagnosis of transplacental infections which demand serologic screening, prophylaxis and treatment of pregnant women is discussed. Attention is paid to urogenital infections (chlamydiosis, genital gerpes, candidiasis, trichomoniasis), genital colonization with groupВ streptococci, mycoplasma, association of different bacteria. Informative methods of laboratory diagnosis and schemes of antibacterial therapy are given.

One elaborated the new mark evaluation scale of gestosis gravity degree with use of modem recommendations of the Worldwide health organization (WHO) and International hypertension society (1999) and the Scientific society for studying of arterial hypertonicity in Russian Federation (2000). According to mark sum one distinguishes gestosis оf light form (0-12 marks), middle gravity gestosis (13-16 marks) and heavy gestosis (17 marks and more ones). Quantitative evaluation scale of gestosis gravity degree allows unify gestosis assess, make prognosis of gestosis course and determinate the treatment effectiveness

It is rightly believed that the establishment of scientific obstetrics in our country was facilitated by the opening of “women’s schools” (1757), the creation of Educational homes in Moscow (1764) and St. Petersburg (1771), the activities of the first Russian professor and “father of Russian obstetrics” Nestor Maksimovich Maksimovich-Ambodik. However, these transformations and the emergence of a domestic obstetric school could not arise out of nothing, out of nowhere. The basis for them was the activity of foreign and Russian doctors who worked in Russia at the beginning of the 18th century.

According to the decision of the board of the Ministry of Health of Russia dated June 21, 2001 (Protocol No. 11) "Maternal and infant mortality in the Russian Federation - condition and prognosis" PREMATURE BABY".