卷 69, 编号 1 (2020)

The problem of postoperative cognitive dysfunction is relevant in obstetrics due to the initial psychophysiological state of a pregnant woman and the high frequency of abdominal delivery everywhere. When choosing the optimal method of anesthesia for a cesarean section, which would minimally affect cognitive functions, it is necessary to consider the impact of anesthesia on the memory and attention of puerperas, as well as their initial cognitive status. To assess memory and attention in women of reproductive age, in our opinion, the most appropriate tests are the MoCA-test, Benton test, Wechsler test, hospital anxiety and depression scale, and a self-assessment questionnaire. These tests are recommended by psychophysiologists and have proven themselves to be well applied in daily clinical practice. Standard test kits with a formalized (quantitative) evaluation of the results allow a rapid assessment of several cognitive functions in a limited time. This review article presents the problem of the cognitive function of pregnant women and postoperative cognitive dysfunction during pregnancy.

Hypothesis/aims of study. Diabetes mellitus (DM) is associated with an increased risk of obstetric complications, including preterm birth (PB). The incidence rate of PB in women with DM is higher than in the general population and amounts to 30–40%. Nevertheless, there are still open questions on the structure of PB, pharmacological approaches to its prevention and treatment, as well as the feasibility of prolonging the timing of glucocorticoid therapy to reduce perinatal morbidity and mortality. The objective of this study was to research the features of structure and clinical approaches in the case of PB in women with different types of DM, based on a literature review.

Study design, materials and methods. The study was performed using literature search, screening, data extraction, and analysis of publications collected in world databases such as MEDLINE, EMBASE, CNKI, and Cochrane.

Results. The rate of PB is the highest in women with pregestational DM: 21–30% in type 1 DM and 19–40% in type 2 DM. The incidence of PB in gestational DM (7–10%) is almost equal to the general population level (7–9%) and depends on the type of diabetes therapy: insulin — 16%, diet — 7%. Risk factors for PB in women with DM are poor glycaemic control, microvascular complications of DM, hypertension, obesity, infection, age, fetal macrosomia, polyhydramnios, and congenital malformations. Adequate glycemic control from early gestation is an important condition for PB prevention. The structure of PB in patients with pregestational DM changes due to an increase in both spontaneous and induced PB proportions. The most common indications for early delivery in DM are preeclampsia, premature placental abruption, impaired renal function in diabetic nephropathy, severe forms of carbohydrate metabolism disorders, diabetic fetopathy, and fetal distress. The risk of fetal respiratory distress syndrome in newborns of mothers with DM is higher than in the general population. The maturity of the lungs of a newborn may be insufficient, even in the case of term delivery. The use of antenatal corticosteroids is effective prophylaxis of respiratory disorders. However, these corticosteroids can increase the risk of neonatal hypoglycemia.

Conclusion. Despite the “term” weight and height, the newborn of a mother with DM may remain immature, therefore, delivery at term is recommended. The gestational age, until which it is advisable to prescribe corticosteroids for pregnant women with DM, and the mode of delivery in the case of PB, remain a matter of debate.

Hypothesis/aims of study. The aim of this study was to assess the efficiency of Mirena (levonorgestrel-releasing intrauterine system) combined with EstroGel (17β-estradiol transdermal gel) being applied in the test group of peri- and postmenopausal women as menopausal hormonal therapy.

Study design, materials and methods. The study involved 62 patients aged 42 to 55 years. The main group included 33 women who were prescribed Mirena in combination with EstroGel. The control group consisted of 29 women who were prescribed a combined two-phase tablet preparation containing micronized 17β-estradiol as an estrogen component and dydrogesterone as a gestagen component. The condition of the patients was evaluated at the beginning of therapy and after 3, 6 and 12 months.

Results. During therapy, patients in the main group decreased climacteric symptoms and improved lipid profile and blood biochemical parameters characterizing the hepatobiliary system. Patients in the control group had a comparable decrease in menopausal symptoms; however, there were changes in biochemical parameters, such as hypertriglyceridemia and a significant increase in bilirubin and transaminases, which required discontinuation of therapy. All the patients using Mirena in combination with EstroGel demonstrated good tolerability, efficiency of the therapy and no significant symptoms requiring its withdrawal. During the menopausal hormonal therapy, there were no cases of relapse of endometrial hyperplasia, growth of myomatous nodes and an increase in endometriosis prevalence. Patients in the control group during the first three months of therapy noted acyclic spotting, breast engorgement and tenderness, headaches, and exacerbation of cholelithiasis, which resulted in decreased adherence to therapy.

Conclusion. The use of estrogen transdermally in combination with the intrauterine administration of levonorgestrel is an effective and safe method that helps to relieve menopausal symptoms and to improve the health and quality of life of women with extragenital pathology, endometrial and mammary gland hyperplastic processes, endometriosis, and menometrorrhagia.

研究现实性。近几十年来，剖宫产术后子宫缝合修复的质量问题一直是人们广泛讨论的话题，其失调会导致肌层的局部变薄发展，形成所谓的疤痕壁龛。

目的是确定剖宫产术后子宫瘢痕局部变薄的原因，确定现有方法评估妊娠期外子宫瘢痕状况的有效性，并发展一种手术矫正这种病理的方法。

材料与研究方法。在4年多的时间里，175名子宫有疤痕的非妊娠患者接受了检查。其中50例被诊断为疤痕壁龛，并行腹腔镜下的子宫成形术。在长期术后期间评估手术的有效性。

研究成果。因娩无力的发展进行剖宫产手术，以及产后复杂的过程是瘢痕生态位形成的重要因素（p < 0.05）。盆腔器官的超声和磁共振成像可检测盆腔肌层的局部变薄，灵敏度为82%和96%，特异性为85%和90%。

结论。诊断瘢痕壁龛的患者行子宫成形术可显著增加子宫肌层厚度（p < 0.05），有助于月经周期的正常化，减轻月经后生殖道出血、痛经、月经过多等症状的严重程度（p < 0.05）。

本文介绍了目前关于子宫腺肌症发展的诊断和发病机制的资料。重点介绍了该病的各种分类。基因和免疫因素在内部子宫内膜异位症的发展的作用被反映。介绍了俄罗斯和国外的研究结果，并描述了最具信息性的子宫腺肌症诊断的无创标志物。

Microbial invasion of the amniotic cavity and subsequent infection process are the leading cause of adverse pregnancy and postpartum outcomes. Intra-amniotic infection can be caused by both pathogenic and opportunistic microorganisms and viruses, but in the vast majority of cases, intra-amniotic infection is associated with the normal microflora of different body sites. In this review article, the current literature data on the role of the placental microbiota in the adverse pregnancy outcomes and on the sources and mechanisms of intra-amniotic infection are summarized.

Hypothesis/aims of study. Recently, due to empowering the improvement of care for patients with traumatic brain injury and creating effective methods of intensive therapy for severe brain lesions of various genesis, there has been a tendency towards an increased number of patients who have gone out of a coma into an unconscious state — a vegetative state or an unresponsive wakefulness syndrome (BS / UWS). The functions of the brain stem and hypothalamus in patients in a BS / UWS are preserved. The aim of this study was to evaluate the significance of the relationship between the regulation of sex steroid hormones and the secretion of neurotransmitters.

Study design, materials and methods. The study was performed using systematic analysis and compilation of literature data obtained by foreign and domestic authors over the period from 1931 to 2018.

Results. This article reviews publications covering the relationship between the regulation of sex steroid hormones and the secretion of neurotransmitters, as well as their effect on the reproductive system. The theory of neurosecretion depicting the mechanisms of positive and negative feedback of the synthesis of neurotransmitters and sex steroid hormones, and the characteristics of the secretion machineries for sex hormones with normogonadotropic and hypogonadotropic pituitary insufficiency, and nonendocrine manifestations of the pathology of the hypothalamus is highlighted in this review.

Conclusion. The hormonal profile of patients with chronic disorders of consciousness remains almost unstudied. A further study of the hormonal profile in this patient category will create the prerequisites for the development of pathogenetically substantiated hormone-modifying replacement therapy, which may have a positive effect on the dynamics of recovery of consciousness and improve treatment outcomes.

长期以来，人们一直在讨论基因和父母教养是否是人格发展的主导因素，作者指出，出生质量是这一过程中第三个同等重要的因素。作者介绍了与孩子身心素质有关的出现概念，这将孩子和父母区分开来，并是基于其独特性、安全性和个体性的反应条件下的模糊性、多因素的影响（心理、社会、
环境），在出生前后的生活中。