Вищий державний навчальний заклад України «Буковинський державний медичний університет» (м. Чернівці, Україна) ЛІКУВАННЯ ВАГІТНИХ ІЗ ПОЛІГІДРАМНІОНОМ Резюме Вступ. Лікування полігідрамніону, як наслідку інфекційного процесу, є складним завданням, оскільки вимагає термінових результатів. У випадку нечутливості умовно патогенної чи патогенної мікрофлори або наявності вірусів, зволікання у лікуванні може призвести до внутрішньоутробного інфікування плоду.Мета дослідження. Оцінити ефективність лікування полігідрамніону вірусного ґенезу. Матеріали та методи дослідження. Проведено клініко-лабораторне обстеження та лікування 60 вагітних із полігідрамніоном та наявністю в анамнезі гострого респіраторного вірусного захворювання або виділено вірус простого герпесу.Методи дослідження, які застосовувалися, -зовнішнє акушерське обстеження, УЗД, мікроскопічний, бактеріологічний, імунофлуоресцентний, імуноферментний.Результати дослідження. Вагітних розділено на дві підгрупи: у першій підгрупі одразу призначалися імунокорегуючі противірусні препарати (n=30), у другій -антибактеріальні препарати, які виявилися неефективними, що було причиною проведення змін у лікуванні (n=30). Для лікування використано імунокорегуючий препарат флавоноїдних глікозидів в дозі 12 крапель двічі на добу per os за 10-15 хвилин до прийому їжі. Через 7-10 днів застосування препарату у 67 % вагітних прояви полігідрамніону зменшилися, через 14 днів у 87 % вагітних не було ознак полігідрамніону.Висновки. Патогенетичне лікування полігідрамніону вірусного ґенезу шляхом застосування імунокорегуючих противірусних препаратів є безпечним високоефективним методом лікування, оскільки, призводить до одуження у 87 % впродовж 10-14 днів, у решти випадків -до позитивної динаміки, що потребує тривалішого лікування. Результати дослідження та їх обговоренняПри порівнянні стану мікробіоценозу піхви у

Menstrual disorders in puberty girls against the background of hormonal imbalance occupy a significant place in the structure of gynecological pathology since in the future, they can lead to stable and irreversible changes in the formation of the reproductive system.The purpose of the work - to study the state of hormonal balance in puberty girls against the background of obesity.Material and methods. 79 adolescent girls with impaired menstrual function on the background of obesity were examined and treated. All subjects were also given a comprehensive examination to determine the level of hormones in the blood serum.Results. It was found that obese adolescent girls have a clear difference in the severity of hyperandrogenic disorders of carbohydrate metabolism and insulin resistance.Conclusion. A clear relationship between the formation of menstrual function and the state of gonadotropic function of the pituitary gland is established. Changes in the hormonal profile of puberty girls were found against the background of obesity, namely hyperleptinemia and leptin resistance, which were corrected by non-drug and drug therapy.

Іntroduction. Today, a quarter of the population of economically developed countries has a body weight that is 15% larger than the norm. According to various authors, the timely onset of menarche in women with various forms of obesity and reproductive dysfunction is observed in 31% of cases only. Obesity results in insulin resistance, which in its turn results in hyperinsulinemia. The main reason of the connection of insulin resistance with reproductive function disorders consists in the specific influence of insulin on ovaries. Insulin suppresses apoptosis, binding to receptors of various growth factors that promotes long existence of atresizing follicles. In the pathogenesis of the metabolic syndrome, along with the development of hyperinsulinemia and insulin resistance, a significant role belongs to the imbalance of adipocytokines, one of which is adiponectin. The aim is to analyze metabolic processes in the formation of menstrual dysfunction in adolescent girls with obesity to improve diagnostic methods of menstrual disorders. Material and methods. Clinical and laboratory examination of adolescent girls aged 12-18 years was held, among which 79 had obesity and complaints about menstrual dysfunction (the main group); 31 with normal body weight and regular menstrual cycle (the control group). Research methods: general clinical, biochemical (indicators of lipid and carbohydrate metabolism were determined), instrumental (ultrasound), statistical. Results. It was found that 53.3% of the girls from the main group had the beginning of the first menstruation after 14 years, delayed menstruation from 42 days to 6 days, duration 2.1 ± 0.05 days, which was significantly shorter, the volume of 10.2 ± 0.05; 0.4 points (average 1-2 pads per day) was significantly lower (p <0.05). Ultrasound showed uterine hypoplasia in almost every second girl in the main group - 36 (45.46%). Hyperleptinemia and leptin resistance was found in obesity of the first degree 34.8 ± 1.75, in obesity of the second degree 37.15 ± 2.12, in obesity of the third degree 40.64 ± 2.0. It was 14.35 ng / ml in the control group, p<0,01. Hyperleptinemia in the main group was accompanied by hyperinsulinemia in 26% of cases and insulin resistance. The relationship between low values of adiponectin and elevated body mass index in patients of the main group was established, which was confirmed by the results of correlation analysis (adiponectin & body mass index: ρ = -0.74). Analysis of the results revealed a decrease of A/L level in the main group by 4.3 times. Based on our own results, the A/L and HOMA-AD models can be considered more accurate for determining insulin resistance. Conclusions. 1. Changes of the menstrual cycle in overweight girls were found. The association of adipokines secretion disorders is characterized by hyperleptinemia, leptin resistance, decreased Adiponectin / Leptin index and hypoadiponectinemia, which, in combination with insulin resistance, indicates the participation of adipokines in the genesis of oligomenorrhea. The algorithm of adolescents’ treatment with menstrual dysfunction on the background of obesity must include the calculation of Adiponectin/Leptin and HOMA-AD, which will make it possible to avoid overdiagnosis of insulin resistance.

Purpose of the study: to establish the frequency of alleles and genotypes of GP IIIa gene polymorphism in adolescent girls with uterine bleeding that is concomitant thyroid pathology and conduct a thorough genetic analysis of patients.Materials and methods. 70 teenage girls with puberty menorrhagia were surveyed. Study groups: I (main) – 30 teenage girls with puberty menorrhagia against the background of thyroid gland pathology, II group (comparison) – 40 teenage girls diagnosed with puberty menorrhagia. Control group consist of 25 almost healthy teenage girls. GP IIIa gene polymorphism (PLA1/PLA2) was studied once using PCR polymerase chain reaction.Results. A1/A2 polymorphism of the GP IIIa gene in adolescent girls with menorrhagia against the background of thyroid pathology indicates the likely prevailing frequency of individuals with “favorable” A1 allele over such with A2A2 genotype with and without pathology: in 12.3 and 9 times respectively. In adolescents without concomitant pathology A1A1 genotype was observed 11.7% more frequently than those with thyroid disease and 15.0% more often than in the control group. Distribution of genotypes of the GP IIIa gene polymorphous locus corresponded to the expected Hardy-Weinberg population balance, both in general and separately in the surveyed groups.Conclusions. In adolescents with menorrhagia without thyroid pathology A1A1 genotype occur 11.7% more frequently than in girls with thyroid diseases and 15.0% more often than in the control group. Relative frequency of A1A2- genotype is 9.2% in girls with menorrhagia and thyroid pathology, and A2A2 genotype by 2.5% over such in adolescents of comparison groups. Thus, risk factors for uterine bleeding with existing thyroid pathology in adolescent girls may depend on gene polymorphism.

Pubertal uterine bleeding occupies an important place in the structure of gynecological pathology since, in the years, it can lead to persistent and irreversible changes in the process of formation of the reproductive system.The purpose of the work is to investigate the effectiveness of non-hormonal therapy in the treatment of uterine bleeding in adolescent girls against the background of concomitant thyroid pathology.Material and methods. Thirty adolescent girls with pubertal uterine bleeding were examined and treated against the background of concomitant thyroid pathology, which were treated in the gynecological department of the city clinical maternity hospital No. 1 in Chernivtsi. All examined patients also underwent a comprehensive examination to determine the level of hormones in the blood serum and to determine individual indicators of hemostasis.Results. It was established that the complex therapy used in adolescent girls suffering from pubertal uterine bleeding against the background of thyroid pathology is effective, as indicated by the positive feedback mechanism, namely the release of follicle-stimulating hormone in response to an increase in the level of estradiol in peripheral blood.Conclusion. The comprehensive treatment technique developed and used by us in adolescent girls with uterine bleeding with concomitant thyroid pathology contributes to the gradual normalization of the level of sex and thyroid hormones in the blood serum, shortens the treatment period in the hospital, and helps to normalize the overall hormonal profile of the examined girls with concomitant thyroid pathology.