РЕЗЮМЕСовременные возможности выбора фармакотерапии миомы матки предоставляют возможность индивидуаль-ного подбора терапии.Цель. Сравнение эффективности лечения миомы матки с применением мифепристона (гинестрила) на основа-нии дифференцированного подхода к назначению двух схем лечения в различной дозировке: 25 мг или 50 мг при ежедневном приёме в течение трёх месяцев.Материалы и методы. Проведено проспективное сравнительное исследование на клинических базах кафе-дры акушерства и гинекологии с курсом перинатологии ФГБОУ ВПО РУДН (Москва) и кафедры акушерства, ги-некологии и перинатологии ФГБОУ ВО КубГМУ (Краснодар). В клинические группы были включены 160 женщин с миомой матки. Рандомизация проводилась двойным слепым методом конвертов.Результаты. Приём мифепристона (гинестрила) в дозировке 50мг в сутки в течение 12 недель и 25мг в сутки в течение 24 недель обладают сопоставимой эффективностью. Заключение. Благодаря оценке субъективных и объективных критериев переносимости препарата возможен ин-дивидуальный подбор дозы мифепристона без ущерба для достижения лечебного эффекта. Russia. Russia, 117198, Moscow, Miklukho-Maklaya str., 8; tel. +7(903)723-22-12; e-mail: radzinsky@mail.ru, ordiyantc@mail.ru 2 Department of Obstetrics, Gynecology and Perinatology Kuban State Medical University Russia, 350063, Krasnodar, Sedina str., 4; tel.: +7(988)2486199; e-mail: vadim23_67@mail.ru SUMMARY Modern options of uterine fibroids pharmacotherapy allow for individual selection of therapy. Aim. To compare the effectiveness of uterine fibroids treatment with administration of mifepristone (Gynestril) on the basis of a differentiated approach to the assignment of two treatment schedules in various dosages: 25 mg or 50 mg per day for three months. V. E. RADZINSKY ¹, I. M. ORDIYANTS ¹, V. A. KHOROLSKY ² COMPARATIVE EFFECTIVENESS OF TWO SCHEDULES OF GYNESTRIL ADMINISTRATION IN TREATMENT OF UTERINE FIBROIDS ¹ Department of Obstetrics and Gynecology with the Course of Perinatology Peoples' Friendship University ofMaterials and methods. A prospective comparative study was conducted at the clinical bases of Department of Obstetrics and Gynecology with the Course of Perinatology of the Peoples' Friendship University of Russia (Moscow) and the Department of Obstetrics, Gynecology and Perinatology of the Kuban State Medical University (Krasnodar). 160 women with uterine myoma were enrolled in the clinical groups. Randomization was carried out by a double-blind method using envelopes.

Aim. Analysis of operative delivery outcomes in pregnant women with abnormal invasive placenta depending on the endovascular treatment for intraoperative haemostasis.Materials and methods. A retrospective study of operative delivery outcomes was performed in 178 patients with placental invasion using ultrasonography (US) data obtained at the Perinatal Centre of the Regional Clinic Hospital No. 2, Ministry of Health of Krasnodar Krai, in the years 2012–2018. In 2012–2014, delivery was managed without endovascular haemostasis (n = 44), and from May 2014 to December 2018 – with prophylactic balloon catheterization of common iliac arteries (n = 134). Upon intraoperative diagnosis of placental invasion, temporary balloon occlusion (TBO, n = 115) and/or uterine artery embolization (UAE, n = 33) were performed. Efficiency of endovascular methods for intraoperative haemostasis was assessed by comparing the degree of placental invasion, amount of blood loss and transfusion, frequency of hysterectomies (HE), duration of surgery, length of stay in intensive care units (ICU) and outcomes for the foetus.Results. Adoption of endovascular methods for intraoperative haemostasis allowed the blood loss (p = 0.02), haemotransfusion (p = 0.012) and HE frequency (p <0.001) to be significantly reduced. In the absence of clinical and histological manifestations of placental invasion, no difference in blood loss was detected between the groups. The amount of blood loss increased with the degree of invasion. Surgery duration in patients with TBO was signifi cantly longer (p = 0.04). No difference was detected between the groups with respect to the ICU length of stay and outcomes for the foetus.Conclusions. Establishment of endovascular haemostasis at the planned delivery of pregnant women with abnormal invasive placenta allows the blood loss and HE frequency to be reduced. Further improvement of US diagnostics of placental invasions is essential in pre-selection of patients for X-ray surgical care.

Aim. This study was designed to evaluate the effectiveness of sequential prescription of drugs for anti-recurrent therapy of the uterine fibroids (UF) and combined oral contraceptives (COC) in pregravidal preparation.Materials and methods.There was conducted a prospective, nonrandomized and controlled cohort study of 150 women with UF  who are planning a pregnancy after the organ-preserving treatment  of uterine fibroids by means of myomectomy with laparoscopic  access and pregravidal preparation. The immunohistochemical (IHC)  study of the intensity expression of Ki 67, p53, Bcl-2 was performed  for the differential diagnosis of reactive proliferation from dysplasia  in the distant fibroid node and the selection of anti-recurrent therapy.Results. The duration of the UF disease does not depend on the intensity of expression of p53, Ki-67 or Bcl-2, the level of expression  of the progesterone receptors in the distant fibroid node. A negative average correlation between the level of hemoglobin  before myomectomy, the duration of the disease (r = -0.3867) and  the number of nodes (r = -0.5389) was revealed. After the end of  the anti-recurrent treatment in women who underwent organ- preserving treatment of uterine fibroids, the prescription of COC is connected with a further decrease in the size of fibroid nodes remaining after myomectomy from 15.81±0.22 mm to 8.94±0.45  mm (p<0.05), the number of fibroid nodes from 2.25±0.08 to  0.91±0.06 (р<0.05).Conclusion.The combination of anti-recurrent therapy with the subsequent prescription of the COC for prevention of the UF growth  in women planning a pregnancy after myomectomy with endoscopic  access is highly effective.