Vol 64, No 2 (2015)

The results of the survey of 214 patients with the complicated pregnancy (a preeclampsia, a premature detachment of placenta, antenatal fetal death, miscarriage) in the anamnesis are presented in the article. We determined the level of molecular markers of a thrombophilia (TAT, D-dimer) and aggregation activity of platelets and carried out antithrombotic therapy to these women. It is shown that 47,7 % of such nonpregnant women and pregnant early terms have the high level of D-dimer, TAT - 46,7 %, aggregation activity of platelets - 52,6 %. Determination of the increased levels of molecular markers of a thrombophilia is the indication to application the antithrombotic therapy and allow to control efficiency of this therapy.

The function condition of hepatobiliar system was investigaited in 120 pregnant with cholestatic hepatosis. The main criteria of cholestatic hepatosis severity were skin itching accompanied with increasing of biliar acids levels, transaminazes activities, alkaline phosphatase and cholesterol levels. Based on clinical and laboratory dates the outcomes of pregnancy and delivery were analysed. There were revealed that pregnancy loss, gestosis, placental insufficiency, IUGR and fetal hypoxia were met more often in groups with middle- and high severe cholestatic hepatosis.

The research of the regulation of respiratory and hemodynamic systems, conducted by modern methods of multivariate correlation analysis (cluster analysis) data monitoring cardiorespiratory system, showed a change of adaptation and regulation after cesarean section with opiate analgesia.

Group B streptococcus (GBS), Streptococcus agalactiae, are the causative agents of severe infection of the fetus and newborn child. The aim of the study was to evaluate the efficacy of antibacterial drugs in women in the III trimester of pregnancy for the prevention of B streptococcal infection. Studied during childbirth and the postpartum period, 70 women colonized by group B streptococcus, treated and not treated with antibacterial perparaty in the III trimester of pregnancy. Evaluated as a new-born children of these women. In pregnant women who received antibiotics in the III trimester of pregnancy, significantly fewer were delayed rupture of membranes, preterm labor, subinvolution uterus. Less common was marked asphyxia. Group B streptococcus significantly more frequently (in 43.5 % of cases) were identified in children born to mothers who did not receive antibiotics during pregnancy. In 26.1 % of these children diagnosed with intrauterine infection. Thus, the use of antimicrobials in the III trimester of pregnancy in detecting GBS in the urine in any quantity, simultaneous detection of these microorganisms in urine and vaginal discharge of a concentration of greater than 104 CFU/ml reduces the rate of preterm birth, postpartum complications, and neonatal asphyxia and intrauterine infection B streptococcal etiology.

Studying of features of a course of pregnancy at the bronchial asthma (BA) and influence of immunological deposits on a placentary barrier was a research objective. Results of this research testify that the main complications of pregnancy at women with bronchial asthma is pregnancy interruption threat, gestosis and placentary insufficiency. Prevention, timely identification of these complications, joint maintaining patients by the obstetrician and pulmonologist allow women practically in all cases to give birth to the full-term healthy children. The greatest number of the immune deposits fixed in a placenta and damaging structures of a placentary barrier (endoteliya of vessels and a membrane of a sintsitiotrofoblast) is found in women with an average and a heavy current BA. Their adjournment is followed by morphological features of an immune inflammation, violation of an immune homeostasis in structures of a placentary barrier. Existence of pathogenic immune complexes in a placenta, and also detection with BA leads an antigen-presenting cells of cages in places of an immune inflammation at women to development of immunopathological process and placentary insufficiency that adversely affects the course of pregnancy, childbirth and can be a predictive factor of development of allergic diseases in the child.

This review aims to provide the reader with an update on the present and potential clinical applications in Doppler ultrasound in perinatal medicine. Umbilical artery Doppler plays an important role in the management of intrauterine growth restriction (IUGR) and preeclampsia and aids in twin-to-twin transfusion syndrome management while notching in the waveform is a predictor of umbilical cord abnormalities. Middle cerebral artery Doppler reliably detects fetal anemia and may be useful in the assessment of IUGR as well. Abnormal uterine artery Doppler may play a role in predicting growth restriction, hypertensive disorders of pregnancy and preterm delivery. Abnormal ductus venosus waveforms can also be used to predict adverse fetal outcome and may allow for better timing of delivery while umbilical venous pulsations may be a sensitive marker for fetal heart failure in hydropic pregnancies. 3D power Doppler allows better small vessel visualization that is not affected by angle of insonation and has been used to diagnose placental and cord abnormalities. Significant improvements have recently occurred, improving the visualization and evaluation of placental vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/ or amplitude-based color Doppler ultrasound. Spatial representation of vascularity can be improved by utilizing 3D processing. Greater sensitivity of 3D Doppler ultrasound to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy. The rapid development of these new ultrasound techniques will continue to enlarge the scope of clinical applications in placental studies. As clinical experience with these new technologies increase and as the technology improves further, it is reasonable to expect that 3D Doppler and 4D ultrasound will be complementary addition to well established 2D Doppler ultrasound imaging.

Pessaries were used in medicine since ancient times, history of their use goes back thousands of years. Throughout its history, pessaries have not changed significantly, so modern products do not differ from the ancients. In modern obstetrics pessaries are used for treatment of cervical incompetence and prevention of premature birth. Transvaginal ultrasound is the gold standard for the evaluation of the cervix during pregnancy and allows a selection of patients with cervical length ≤25 mm for pessary installation. To date, the installation of pessary may be the main strategy for the treatment and prevention of threatened pregnancy termination in the II and III trimester of pregnancy.