Gestational pemphigus — is a rare autoimmune condition that manifest during pregnancy. This pathology was described for the first time in 1827 by the Karl Martius, but until now remains insufficiently studied and as a result, difficulties arise in the differential diagnosis and treatment. Clinical manifestations of the disease characterized by the appearance of a polymorphic rash on the skin and mucous membranes. In patients with impaired immune tolerance pemphigus can be complicated by hyperactivation of the immune system. To date, pregnancy is not considered as a factor that can aggravate the course of pemphigus, since during pregnancy the disease can worsen, enter into complete remission, or remain unchanged. In the literature, there is information about the manifestation of pemphigus in puerperium after rapid decrease of corticosteroid hormones in serum. The clinical course of gestational pemphigus is variable and can lead to diagnostic failures. The diagnosis usually made according to the clinic, histopathology and laboratory findings. In this case report we describe a case of diagnosis and treatment of gestational pemphigoid, refractory to corticosteroid therapy. Clinical improvement and recovery achieved after a course of high doses of intravenous immunoglobulins. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pemphigoid, pregnancy, autoimmune disease, intravenous immunoglobulin.

Nowadays, for understanding the mechanisms of hemostasis used the «cascade» (the waterfall) model for process of blood clotting. From the end of the 19th century, scientists have been trying to unravel the mechanism of blood clotting, simulate hemostasis. Attempts to assess the system as a whole, as a single functioning complex, led to a method, known as, thromboelastography (TEG). The objective: examine the value of the TEG in prevention of bleeding in pregnant with a low level of platelets. Patients and methods. Аnalysis of pregnant women during the third trimester with a level of platelets below 150*109/l was done. All women tested with TEG method. The main group (MG) consist of 91 woman with changes in the hemostasis system. MG randomly divided into 2 subgroups. In the I subgroup 48 women received infusion of blood components. In the II subgroup 43 women without correction in system of hemostasis. The control group (CG) consist of 44 women with platelet level more than 150*109/l, without pathological changes according to TEG. Results. Comparison of blood loss during childbirth and cesarean section in subgroup I and II, as well as in CG, demonstrates less blood loss I subgroup in comparison with II subgroup (p < 0.05). Smallest blood loss noted in CG compared to the MG (p<0.05). Conclusions. 1. Our research shows the value of the TEG in bleeding prevention in women with low levels of platelets. In general, TEG method shows the overall status of the hemostatic system in vivo. 2.Determination of indicators of the hemostatic system is extremely important, especially in cases where it expected to «mandatory» blood loss during childbirth, surgeries etc. Proper correction hemostatic changes based on TEG data helps to prevent the development of massive bleeding. Key words: thromboelastography, obstetric hemorrhage, thrombocytopenia, hemostasis.

Global data show that the probability of occurrence of placenta praevia is increased after treatment with the use of assisted reproductive technology (ART) from 2 to 6 times. However, until now it remains unknown what factors contribute to this increased risk. The objective: perform a retrospective analysis of histories of the births which were complicated by placenta praevia. Determine the frequency of this pathology in the control group where the pregnancy was the result of self-fertilization and the group where the pregnancy was the result of ART. Patients and methods. We have processed statistically the 20 919 birth histories from four Kyiv hospitals (№ 1, 2, 5 and 7) that took place in 2015. ART pregnancy occurred in 391 cases. Results. The retrospective analysis of birth histories found 86 placenta praevia that was 0.38% of the total number of births. 8 cases of placenta praevia that was 2.04% were found among 391 ART pregnancies. Thus placenta praevia in ART group is 5 times greater than in control group of natural pregnancies. Intrauterine pathology was detected in 63% cases of ART pregnancies which was 2.5 times higher than the control group. Conclusions. ART increases the number of pregnant women with placenta praevia in 5 times in comparison with natural pregnancies. Pregravid training with operative treatment in case of the intrauterine pathology reduces the number of pregnancies with the placenta praevia. The obtained data did not allow determining the final mechanism of occurrence of placenta praevia. Key words: аssisted reproductive technology, intrauterine pathology, placenta praevia.

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