卷 69, 编号 3 (2020)

Hypothesis/aims of study. In the past 15 years, statistical reports have standardly identified five main causes of perinatal loss: hypoxia / asphyxia and its consequences, congenital malformations, respiratory disorders, intrauterine infections, and birth injuries. The cause of perinatal loss is indicated in 17-83% of cases, but this percentage can be increased by a careful analysis of the course of pregnancy, childbirth, and the results of autopsy. The aim of this study was to analyze the frequency of verification of the causes of perinatal death in St. Petersburg and the Leningrad Region for 2006-2018.

Study design, materials and methods. The methodology of determining the cause of perinatal loss in St. Petersburg and the Leningrad Region for 2006-2018 was analyzed according to the reports of the St. Petersburg State Budgetary Healthcare Institution “Medical Information and Analytical Center”) and the Leningrad Regional State Budgetary Healthcare Institution “Medical Information Analytical Center”, as well as the Leningrad Regional Pathological and Anatomical Bureau. Further, the frequency of cases in which the cause of perinatal loss was not indicated was estimated in dynamics over the analyzed period.

Results. The methodology and problems arising in establishing the basic diagnoses were studied: intrauterine hypoxia (P20.0), asphyxia during childbirth (P21), respiratory disorders in the newborn that occurred in the perinatal period (P22-P28), and hemorrhagic and hematological disorders in the fetus and newborn (P50-P61). Differences in the frequency of diagnosis of causes of death in Leningrad Regional Pathological and Anatomical Bureau are explained. Those are due to the methodology for establishing a diagnosis of chronic placental insufficiency (O43.8, other placental disorders: dysfunction, heart attack) based on the detection of hypoxic cardiopathy at autopsy, and due to the approach developed by the institution to detect intrauterine infections. The frequency of cases in which the cause of perinatal loss was not indicated was estimated, the reasons and possibilities of this being explained.

Conclusion. Low information content of the official statistical reports makes it difficult to analyze the real causes of perinatal loss.

研究现实性：30%以上体重超标和肥胖的育龄妇女存在卵巢功能不全。关于瘦素对生殖系统、卵巢激素生成和卵巢激素不全食饵性肥胖女性的显著影响的数据被提出。肥胖治疗对纠正高瘦素血症和恢复激素和排卵功能的育龄妇女食饵性肥胖的效果是值得关注的。

目的是研究肥胖治疗对育龄妇女瘦素水平和卵巢激素功能的影响。

材料与研究方法。所有的妇女都进行了临床和实验室检查，包括病史信息、人体测量学（测量身高和体重，腰围和臀围，计算身体质量指数），血压测量、妇科检查、测定促性腺激素、性激素、胰岛素、血瘦素、血生化参数、空腹血糖和糖耐量试验，盆腔超声、全身骨密度测量仪。调查数据和客观调查数据被录入专门设计的问卷，其中包括以下指标：患者的年龄、初潮的年龄、月经周期的性质、怀孕、分娩和生殖计划的数据、妇科和躯体疾病。

研究成果。研究了体重减轻后瘦素、雌二醇、卵巢卵泡数与排卵功能恢复的关系。建立了一个数学模型来估计体重减轻后排卵恢复的概率。分析了二甲双胍、西布曲明治疗对减肥后排卵恢复的影响。

结论。获得的结果使我们能够确定体重减轻后因超重和食饵性肥胖导致无排卵的患者血液中瘦素和雌二醇指标、窦卵泡数量和胰岛素抵抗与实现排卵相关的预后价值。对比服用药物治疗食饵性肥胖的妇女与服用二甲双胍和西布曲明的妇女，排卵恢复的频率没有显著差异。

该综述展示了临床和实验研究的结果，表明神经精神疾病的高发病率以及宫内发育期间的不良反应机制，其不良反应决定了肥胖和/或糖尿病母亲的子女的长期后果。考虑在计划阶段和怀孕期间采取预防措施。

Hypothesis/aims of study. Endometriosis is a multifactorial, chronic and recurring condition that has a multifaceted negative impact on women’s fertility. The aim of the study was to assess the effect of genital endometriosis on the female reproductive system and pregnancy using the literature.

Study design, materials and methods. The review was performed by analyzing the articles published mainly over the last 5 years and deposited in PubMed Central, ScienceDirect, and Cyberleninka bibliographic databases.

Results. Current data for the management of patients with endometriosis, pathogenetic and pathophysiological mechanisms of infertility, and complications arising during pregnancy in patients with endometriosis are presented in this review article.

Conclusion. In patients with endometriosis, individualized management of the disease, full periconceptional multivitamin supplementation and the developed strategy of prenatal care should be taken to overcome infertility and to prevent or minimize the risk of complications associated with pregnancy.

This article presents a clinical case of pubic symphysis diastasis in a pregnant woman with atypical clinical features. From 24 weeks of gestation, the patient noticed an intermittent low back aching pain radiated to posterior surface of the right thigh. The pain was regarded as a manifestation of lumbar osteochondrosis, and the patient did not receive specific treatment. At 39-40 weeks of pregnancy, the woman complained of severe pain in the left iliac region that appeared while lying on the left side or turning in bed. The differential diagnosis included acute abdomen and pubic symphysis diastasis. During diagnostic research, clinical features of acute abdomen were not found. The diagnostic tests such as tenderness palpation of pubic symphysis, P4 test, Patrick’s test, modified Trendelenburg’s test, and Mennell’s test were positive. Accor­ding to ultrasound, the width of the pubic symphysis was 8.9 mm, with a 2 mm deviation of pubic ramus relative to the sagittal plane, ill-defined margin and inhomogeneous structure of the symphysis due to hypoechogenic inclusions with a total area of about 50%. Thus, the patient was diagnosed with pubic symphysis diastasis of the 2^nd degree. Given the severe pain syndrome and a high risk of pubic symphysis fracture during labor, this case required surgical delivery. The postoperative period elapsed without complication.

Hypothesis/aims of study. The perinatal mortality rate is a comprehensive indicator of social well-being, economic deve­lopment and the state of medical care in any country. The aim of this study was to analyze perinatal loss dynamics in St. Petersburg and the Leningrad Region for 2006-2018 so as to determine the reserves for the reduction of perinatal mortality.

Study design, materials and methods. Regional statistical reports on perinatal mortality in St. Petersburg and the Leningrad Region for 2006-2018 were analyzed.

Results. A retrospective analysis of perinatal loss dynamics in St. Petersburg and the Leningrad Region was carried out. The structure of perinatal losses by birth weight of the fetus / newborn was surveyed. The proportion of children who died perinatally in the total number of deaths before reaching the age of 18 was determined. The main reserves for reducing perinatal mortality have been identified.

Conclusion. With a clear tendency for perinatal mortality in St. Petersburg and the Leningrad Region to decrease during the study period, the absolute number of stillbirths does not show such a tendency.