Saratov JOURNAL of Medical and Scientific Research

Obstetrics and Gynecology

Evaluation of efficiency of tactics to improve the preterm birth results (review)

Year: 2020, volume 16 Issue: №1 Pages: 17-23
Heading: Obstetrics and Gynecology Article type: Review
Authors: Yakovleva O.V., Glukhova T.N., Rogozhina I.E.
Organization: Saratov State Medical University
Summary:

The review is devoted to the assessment of the effectiveness of measures to improve the outcome of preterm birth. An analysis of randomized multicenter studies from 2014 to 2019 of the database of the National Library of Medicine PubMed was carried out. Information is presented on the effectiveness of the prevention of respiratory distress syndrome, tocolytic therapy, neuroprotection of the fetus, systemic antibacterial therapy.

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Perioperative and long-term cesarean section complications: a systematic review

Summary:

The aim of the review is to analyze the complications of cesarean section (CS), the associated maternal and perinatal mortality, taking into account the economic development of the country, indications for CS, urgency, methods of surgery and anesthesia, and preventive measures. For a systematic review, a search was conducted on electronic research databases reporting maternal or perinatal morbidity and mortality associated with CS. The analysis included 167 studies, including 5,100,161 operations of CS and 8216 cases of maternal mortality meeting the inclusion criteria. The prevalence of complications associated with CS was calculated, the odds ratio (OR) and the relative risk (RR) with confidence interval (Cl) 95% were calculated. The risk of death for women in low- and middle-income countries who had CS was 7.6 per 1000 [95% Cl: 6.6-8.6]; in highly developed countries 0.6 per 1000 [95% Cl: 0.08-0.9]. In low-income countries, perinatal mortality was 84.7 per 1000 CS [95% Cl: 70.5-100.2]. Perinatal mortality in high-income countries is 12.7 per 1000 cops [95% Cl: 6.85-18.3]. The most common perioperative complications in CS were: bleeding (OR=0.52 [95% Cl: 0.48-0.57]), infection (OR=13.4 [95% Cl: 9.7-22.3]) and venous thromboembolism (OR=1.4 [95% Cl: 1.2-3.5]). Low-income countries have high maternal mortality and require optimized conditions for CS. A significant increase in the incidence of CS in high-income countries did not lead to a corresponding decrease in neonatal morbidity and mortality, but it increased the risk to the health and life of women.

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Pregnancy and cervical intraepithelial neoplasia

Year: 2019, volume 15 Issue: №1 Pages: 19-23
Heading: Obstetrics and Gynecology Article type: Review
Authors: Yakovleva O.V., Glukhova T.N., Rogozhina I.E., Skupova I.N.
Organization: Saratov State Medical University
Summary:

The review of literature is devoted to the problem of cervical intraepithelial dysplasia in pregnant women. For the analysis, publications in the PubMed from 2013 till 2018 database were used.

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Comparative analysis of efficiency of two techniques of endoscopic organ sparing surgery at ectopic tubal pregnancy

Year: 2019, volume 15 Issue: №1 Pages: 14-18
Heading: Obstetrics and Gynecology Article type: Original article
Authors: Fetisheva L.E., Mozes V.G., Mozes K.B.
Organization: Kemerovo State Medical University
Summary:

Aim: to compare the effectiveness of salpingostomy with the subsequent evacuation of the ovum and the resection of a part of the ampulla of the fallopian tube with the ovum and the subsequent neostomatoplasty in the treatment of tubal pregnancy. Material and Methods. A retrospective randomized study of the effectiveness of two techniques of endoscopic organ-sparing surgical treatment of ectopic tubal pregnancy was conducted. Results. The time for performing salpingostomy and resection was 11.8±1.5 minutes and 21±2 minutes, respectively (U[12458]=0, p=0.001). Compared with salpingostomy, the thread did not lead to the appearance of a trophoblast, which was accompanied by a decrease in the degree of adhesions in the pelvis in the third month of observation (PAI showed 2 (2; 2) and 0 (0; 1) points, respectively U =759, p=0.001; R-AFS corresponded to the minimum degree of severity: 2(0; 2) and 0 (0; 0) points, respectively (U4 =1076, p=0.001); according to the modified classification of the degree of adhesions in the pelvis after cesarean section corresponded to the minimum degree of severity: 4 (0;4) and 0 (0;4) points, respectively (U[12458]=2617, p=0.006)and more frequent the operated fallopian tube (30.6% and 58,6%, respectively, p=0.001)was accompanied by a more frequent onset of spontaneous uterine pregnancy by the 12th month of observation (12.9% and 29,3%, respectively, p=0.007) and delivery to 18 months of observation (3.2% and 15.5%, respectively, p=0.001). Conclusion. Despite the higher technical complexity, resection of a part of the ampulla of the fallopian tube with a fetal egg and subsequent neostomatoplasty is an effective alternative to salpingostomy andmay be used in women with an ectopic pregnancy wishing to preserve reproductive function.

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Comparative analysis of efficiency of two techniques of endoscopic organ sparing surgery at ectopic tubal pregnancy

Year: 2019, volume 15 Issue: №1 Pages: 14-18
Heading: Obstetrics and Gynecology Article type: Original article
Authors: Fetisheva L.E., Mozes V.G., Mozes K.B.
Organization: Kemerovo State Medical University
Summary:

Aim: to compare the effectiveness of salpingostomy with the subsequent evacuation of the ovum and the resection of a part of the ampulla of the fallopian tube with the ovum and the subsequent neostomatoplasty in the treatment of tubal pregnancy. Material and Methods. A retrospective randomized study of the effectiveness of two techniques of endoscopic organ-sparing surgical treatment of ectopic tubal pregnancy was conducted. Results. The time for performing salpingostomy and resection was 11.8±1.5 minutes and 21±2 minutes, respectively (U[12458]=0, p=0.001). Compared with salpingostomy, the thread did not lead to the appearance of a trophoblast, which was accompanied by a decrease in the degree of adhesions in the pelvis in the third month of observation (PAI showed 2 (2; 2) and 0 (0; 1) points, respectively U =759, p=0.001; R-AFS corresponded to the minimum degree of severity: 2(0; 2) and 0 (0; 0) points, respectively (U4 =1076, p=0.001); according to the modified classification of the degree of adhesions in the pelvis after cesarean section corresponded to the minimum degree of severity: 4 (0;4) and 0 (0;4) points, respectively (U[12458]=2617, p=0.006)and more frequent the operated fallopian tube (30.6% and 58,6%, respectively, p=0.001)was accompanied by a more frequent onset of spontaneous uterine pregnancy by the 12th month of observation (12.9% and 29,3%, respectively, p=0.007) and delivery to 18 months of observation (3.2% and 15.5%, respectively, p=0.001). Conclusion. Despite the higher technical complexity, resection of a part of the ampulla of the fallopian tube with a fetal egg and subsequent neostomatoplasty is an effective alternative to salpingostomy andmay be used in women with an ectopic pregnancy wishing to preserve reproductive function.

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Functional and role status of obstetricians and gynecologists in the process of obstetric care.

Year: 2017, volume 13 Issue: №3 Pages: 475-480
Heading: Obstetrics and Gynecology Article type: Original article
Authors: Tkachenko L.V., Sedova А.А., Shestakov А.А., Gritsenko I.A.
Organization: Rostov-on-Don State Medical University, Volgograd Medical Scientific Center, Volgograd State Medical University
Summary:

Objective: to determine the ratio of obstetricians and gynecologists roles during childbirth. Material and Methods. The questioning of obstetricians and gynecologists in the Volgograd and Rostov region has been conducted. The population was 1181. Sample random N=300. Results. Respondents acknowledge their own responsibility in 98%. Midwives agree that a woman is the main actor in the process of childbirth, but just 52,7% consider that it is necessary to inform a woman of principle for her birthing situations and do not trust its ability to make adequate decisions (52%). Conclusion. Obstetricians and gynecologists consider themselves the main actors of the process of childbirth, although not rule out the usefulness of the participation of other health professionals, respected the autonomy of women in decision-making, but prefer a higher level of confidence on the doctor. The application of advances personalized medicine is considered necessary for 69.7% of respondents, while recognizing their lack of awareness on this issue.

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Manifestations of pathomorphosis at pregnant women with heart diseases

Year: 2017, volume 13 Issue: №2 Pages: 233-238
Heading: Obstetrics and Gynecology Article type: Original article
Authors: Kazachkova E.A., Kazachkov E.L., Vorobiev I.V.
Organization: South Ural State Medical University
Summary:

Purpose: to study the structure of heart defects in pregnant women, the features of the medico-social portrait, the course of pregnancy and perinatal outcomes in patients with heart defects in the light of pathomorphosis. Material and Methods. A retrospective clinical and anamnestic analysis of the medical documentation of 165 patients delivered in the maternity hospital of the Municipal Health Care Institution of the City Clinical Hospital No. 6 in Chelyabinsk in 1991-1994 was conducted, (group 1)and a prospective cohort study of 168 patients who were delivered to this hospital between 2011 and 2014 (group 2) in accordance with a modified WHO classification for assessing the risk of cardiovascular complications for the mother and offspring, the characteristics of the medico-social portrait, The course of pregnancy and perinatal outcomes in patients with heart defects in the light of the doctrine of pathomorphosis. Results. It is established that over the past 20 years, there have been significant changes in the structure of heart diseases, the medical and social characteristics of patients with this disease, complications of gestation, which must be taken into account when choosing the optimal tactics for pregravid preparation, pregnancy in women with heart defects. Conclusion. The significant changes in the structure and frequency of heart defects observed in modern pregnant women with heart defects, in the features of the medical and social portrait of these patients, and also during pregnancy, childbirth and perinatal outcomes, can be treated as pathomorphosis in the clinical (narrow) sense.

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Experience of office hysteroscopy for diagnostics of abnormal uterine bleeding causes in puberty girls

Year: 2016, volume 12 Issue: №3 Pages: 339-343
Heading: Obstetrics and Gynecology Article type: Original article
Authors: Bezhanishvili Е.М., Svinarev M.Yu.
Organization: Saratov Regional Child Clinical Hospital
Summary:

Objective: to prove the role of office hysteroscopy as an important additional method in diagnostics of puberty abnormal uterine bleeding (AUB). Material and methods. The study involved 68 patients with AUB. The average age was 13.4 years (10-17 years). The main complaint of patients concerned bleeding from genital tract during 10-45 days (on an average 28.4 days). Patients were divided into 3 groups according to the type of AUB determined based on the level of serum estradiol, physical and sexual development, internal genitalia ultrasound data: 35 hypo estrogenic girls, 24 girls with normal estrogenic and 9 girls with hyper estrogenic type of AUB. All of the girls took the office hysteroscopy. Results. When performing hysteroscopy it was revealed that there were a clear relationship between the degree of estrogenic saturation and visual picture obtained in the course of the study. Conclusion. Hysteroscopy enables maximum visualization of uterine cavity, which allows to verify the diagnosis, to reduce the "over diagnosis" rate of organic pathology, perform a differentiated approach to treatment of diseases, based on determination of estradiol level in serum and data obtained in the study.

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Retrocervical endometriosis: etiology, pathogenesis, classification, diagnosis and treatment

Year: 2016, volume 12 Issue: №2 Pages: 138-144
Heading: Obstetrics and Gynecology Article type: Review
Authors: Tarlamazian A.V., Stolyarova U.V.
Organization: Saratov State Medical University
Summary:

The review deals with contemporary issues of etiology, pathogenesis, classification, diagnosis and treatment of retrocervical endometriosis on the basis of existing data in the literature on this disease. Among the various forms of endometrial disease incidence retrocervical endometriosis, according to various authors, is 30-34%. The process is characterized by the formation of deep infiltrative lesions, originating from the recto-vaginal septum, without capsules and clear boundaries, extensively localizing, affecting the adjacent organs with the formation of scar-adhesions and characterizing this pathology as a multi-disciplinary (gynecological, surgical, urological). There are many options etio-pathogenesis of retrocervical endometriosis, but none of them fully explains the diversity of forms of expression and localization of this pathology. Particular attention is paid to the influence of immune and hormonal factors on the development of the disease. It is noted that currently there is no single universally accepted by clinicians and morphology full classification of retrocervical endometriosis, and there are no generally accepted standards of its diagnosis. The variants of the treatment of this disease have been considered including hormonal and immunomodulatory therapies.

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Serotonin system in premenstrual syndrome occurrence

Year: 2016, volume 12 Issue: №2 Pages: 136-138
Heading: Obstetrics and Gynecology Article type: Review
Authors: Rogozhina I.E., Ignatova M.B.
Organization: Saratov State Medical University
Summary:

The review presents the published data on relevance of problem, frequency rate and the mechanisms of occurrence of premenstrual syndrome, the necessity of complex treatment of premenstrual syndrome has been proved.

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