One of the leading conditions that complicates the course of pregnancy and adversely affects the condition of the woman, the fetus and the newborn is the mother’s diabetes mellitus. The objective of this paper is to study the features of pregnancy, childbirth and fetal development and women with diabetes of varying severity. Matherials and Methods. 185 pregnant women with diabetes mellitus were examined: 1 group – 25 women with mild diabetes; 2 group – 50 women with moderate severity; 3 group – 48 women with severe; 4 group – 29 women with gestational diabetes mellitus. The control group consisted of 30 healthy women who had uneventful pregnancy and childbirth. Results. The analysis of 185 cases of the course of pregnancy monitoring and childbirth in patients with diabetes mellitus of various degrees of severity and gestational diabetes mellitus revealed a direct relationship between the form and severity of diabetes mellitus with the frequency of complications of pregnancy and childbirth, the degree of degenerative changes in the placenta, deterioration of the fetal state, as well as perinatal morbidity and mortality. Conclusions. In patients with gestational diabetes, with mild, moderate and severe diabetes, pathological changes in the placenta are more often detected by histochemical and ultramicroscopic studies, compared with microscopic and macroscopic methods, which can be used for early diagnosis and prevention of complications in this category of patients.

Pelvic inflammatory diseases (PID) are on the second place in the structure of gynecological incidence. It has been proven, that PID develops in case of disturbed immune balance and often complicated by pelvic adhesions. Aim - to study in a comparative aspect the features of expression and distribution of proinflammatory cytokines (IL-1, IL-2, IL-6 and TNF-a) in the tissue of intact pelvic peritoneum and adhesions in women of reproductive age with PID, and evaluate the effectiveness of the proposed method of prevention of pelvic adhesions at women of reproductive age. Materials and methods. One hundred patients of reproductive age suffering from tubal and peritoneal form of infertility, who had a history of chronic PID and pelvic adhesions and thirty healthy women in the control group, were included at this study. Results. The presence of macrophages and proinflammatory cytokines IL-1, IL-2, IL-6 and TNF-a in adhesions of the abdominal cavity in patients with PID is the evidence of their internal inflammatory activity. According to the received data, the number of patients without pelvic adhesions was 4.3 times higher in the main group compared to the control group. Сonclusion. The proposed scheme of pelvic adhesions prevention, taking into account the pathogenic role of inflammatory disorders in the adhesiogenesis, allows to reduce the adhesion after the surgical treatment in 4.3 times and the density of the reformed adhesions in 8 times.

The article describes a rare clinical case of ectopic pregnancy in the uterine scar left after a cesarean section. The case demonstrates the complexity of diagnosing this abnormality and managing such patients. The proposed approach allowed us to diagnose pregnancy in the uterus scar in due time, avoid hysterectomy, and preserve the reproductive organ.

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Here we describe a rare clinical case of female with a history of surgical sterilization coupled to ectopic pregnancy in the fallopian tube stump, comprising on average 1.19 % of total ectopic pregnancies. The patient E. was admitted to the gynecological department complaining of aching pain in the lower left abdominal quadrant, blood discharge from the genital tract, and delayed menstruation. Due to a previous operation for sterilization, no onset of pregnancy was expected. A positive urinary test for human chorionic gonadotropin was obtained, whereas ultrasound examination did not reliably confirm the onset of pregnancy. However, taking into account the ultrasound signs of the hematoperitoneum, a culdocentesis was performed that revealed dark liquid non-clotting blood. Laparoscopic surgery was performed on emergency indications. Intraoperatively: the stump of the left fallopian tube was dilated, cyanotic, and blood was leaking from the fimbria lend. Bilateral excision of fallopian tube stumps was performed. The primary clinical diagnosis was interrupted left-sided tubal pregnancy (in the fallopian tube stump) that was confirmed by pathomorphological examination. Thus, the clinical case described by us demonstrates properly conducted differential diagnostics as well as timely management and therapeutic interventions. Hence, previous surgical sterilization recorded in patient history should not rule out a diagnosis of ectopic pregnancy.