No abstract

Проведен анализ основных проблем беременности после вспомогательной репродуктивной технологии (ВРТ). Подчеркнуто, что бесплодие, как и субфертильность, являются независимыми факторами риска для индукции акушерских осложнений и неблагоприятных перинатальных исходов даже вне ВРТ. Здоровье пары до зачатия вносит свой значительный отрицательный вклад в груз формирования акушерской патологии на протяжении беременности. Установлено, что возраст и высокий уровень эстрогенов являются независимыми предикторами гиперкоагуляции. Доказано, что генетический полиморфизм к тромбофилии не влияет на исход беременности после ВРТ. Тестирование на АФС чаще обнаруживает положительные результаты среди женщин с бесплодием, но не обнаружена корреляционная связь между АФС и исходом после ВРТ. ВРТ ассоциировались с повышенным риском преждевременной отслойки нормально расположенной плаценты, предлежания плаценты, вращения плаценты, vasa previa. Суммированы основные акушерские осложнения со стороны матери, плода и новорожденного. Показана значительная роль ВРТ в возникновении таких осложнений беременности, как плацентарная недостаточность, преэклампсия, многоплодие. Отмечен высокий риск формирования маловесного к сроку гестации плода, недоношенности, массивных кровотечений. Подчеркнуто, что лечение c использованием ВРТ может предрасполагать последующее потомство к повышенному риску хронических заболеваний, влияющих на качество и продолжительность жизни. Ключевые слова: вспомогательные репродуктивные технологии, осложнения беременности, исход для плода и новорожденного

The article is a description of the effectiveness of treatment of patients of reproductive age with chronic nonspecific exo-, endocervicitis and vaginitis in the presence of benign and precancerous diseases of the cervix of the uterus of mild degree. Comparative characteristics of the use of the combined preparation for intravaginal administration Elzhina and intravaginal administration of metronidazole with oral fluconazole were carried out. The advantages of using the drug Elzhina in terms of preoperative preparation over the use of radio wave excisional and surgical methods of treatment are noted. The efficacy, tolerability, and safety of the therapy were also evaluated in both treatment options. It is noted that the drug containing ornidazole 500 mg, prednisolone 3 mg, econazole 150 mg, neomycin 65 000 IU, will reduce the severity of inflammatory processes, which has a beneficial effect on the results of radio wave and surgical methods for the treatment of benign and precancerous diseases of the cervix. Against the background of chronic, long-term nonspecific exo-, endocervicitis and vaginitis

Aim. To optimize preventive measures for miscarriage after appendectomy based on a study of the gestation course pathogenetic features in acute appendicitis. Methods. 78 pregnant women who had underwent surgery for acute appendicitis during gestation (gestation term from 4 to 30 weeks) were examined. The control group consisted of healthy 37 women with normal gestation. Serum prolactin level was measured by ELISA. Leukocyte intoxication index, combined endotoxin titre, coagulation tests (fibrinogen, soluble fibrin monomers, activated partial thromboplastin time, fibrinolysis time) were also examined. serum cytokine levels (interleukine-1β, -2, -4, -6, interferon γ, tumor necrosis factor α) were measured by solid-phase enzyme immunoassay. Patients of comparison group (n=42) received standard treatment targeted on pregnancy prolongation after the surgery. Discrete plasmapheresis was added to treatment offered for patients of the main group (n=36) at 3rd and 5th days after the appendectomy. Results. Endogenous intoxication syndrome development in association with hyper coagulation and simultaneous fibrinolysis inhibition and increase of paracoagulation products levels combined with pro-inflammatory cytokines level increase was noted in pregnant patients with appendicitis. Prolactin level increased by 1.5-1.8 times at 5-7 days after surgery with further decrease at 10-14 day accompanied by risk of miscarriage. The use of discrete plasmapheresis at 3rd and 5th days after surgery contributes to maintaining stable concentrations of prolactin in pregnant women in all terms during the postoperative period, as well as endogenous intoxication indicators decrease, hemostasis and cytokine profile normalization, allowing to increase the rate of successful pregnancy outcomes after appendectomy. Conclusion. Addition of plasmapheresis as a component of complex treatment in pregnant women after appendectomy allowed to reduce the risk of miscarriage by 4 times, and the rate of miscarriage by twice, suggesting this method as a safe and effective way to prevent miscarriage.