Гестоз и его крайние степени тяжести -преэклампсия, эклампсия остаются одной из главных проблем акушерской науки и практики. В этом осложнении беременности сконцен-трировано множество нерешенных вопросов, от спорных клас-сификаций тяжести до причин развития и поисков выбора оп-тимальной тактики ведения беременности и родоразрешения.Гестоз является не только непосредственной причиной материнской смертности, но и индуктором многих случаев массивных кровотечений и гнойно-септических осложнений. Внедрение в акушерскую практику современных медицинских технологий, оптимизация принципов оказания акушерской помощи, безусловно, снизили в последние годы материнскую смертность вследствие тяжелых форм гестоза и связанных с ним осложнений. Об этом убедительно свидетельствует дина-мика показателей материнской смертности от эклампсии по Санкт-Петербургу (табл. 1). В то же время снижение показате-ля материнской смертности от преэклампсии не сопровожда-ется снижением в целом высокой частоты развития гестоза.Возникает вопрос, какие фоновые причины влияют на час-тоту осложнения беременности гестозом, можно ли эффектив-но предупреждать развитие таких серьезных состояний, свя-занных с гестозом, как эклампсия, острые формы синдрома ДВС, преждевременная отслойка нормально расположенной плаценты (ПОНРП), необратимая недостаточность функции отдельных органов и систем, послеродовые воспалительные заболевания?Какие структуры преемственного акушерского наблюдения остаются недостаточно эффективными в профилактике тяжелых форм гестоза и какой алгоритм акушерской тактики наиболее при-емлем в целях снижения материнской смертности от гестоза?В настоящей работе обсуждение указанных вопросов про-ведено на основе анализа случаев материнской смертности от гестоза со сравнением двух периодов акушерской практики. Исследованы материалы по 57 случаям материнской смертно-сти от тяжелого гестоза в период с 1966 по 1984 гг. и 18 случа-ям в период 1996-2012 гг. (один случай из 18 зарегистрирован в группе материнских смертей от кровотечений).Анализ позволяет сделать несколько принципиальных выводов. 1. Тяжелые формы гестоза, как правило, развиваются на небла-гоприятном соматическом фоне. Иными словами, развитие преэклампсии -эклампсии по сути отражает непереноси-мость беременности исходно больным организмом. Так, со-гласно данным аутопсии (соответственно 45 и 18 протоколов по представленным этапам наблюдения), фактически у каж-дой погибшей женщины выявлено одно и более экстрагени-тальное заболевание.
Objective: evaluate clinical significance pituitary incidentalomas, apparently derived from gonadotropocytes. Design: follow-up study. Patients. Three observations of pituitary microadenomas in patients whose cause for treatment was prolonged amenorrhea. Diagnosed uterine hypoplasia, decreased ovarian reserve, decreased bone mass. Patients combined expressed psycho-emotional symptoms (depression, neuroticism up to mental disorders in one case). The diagnosis of a gonadotrophic incidentaloma is suspected after exclusion of clinical and laboratory signs of prolactinoma, somatotrophic, corticotrophic and thyrotrophic adenoma. Results. In two cases, the clinical picture of severe estrogenic failure was combined with high concentrations FSH, LH and low concentrations of anti-mullerian hormone (AMH). The increase in gonadotrophines, obviously, was both a reaction to a decreased production of estrogens, and the result of their hypersecretion by adenoma. In the observed cases there was no development of ovarian cysts, characteristic for patients with gonadotrophic adenomas, which can be explained by a reduced ovarian reserve. In the third case marked initially normal secretion of FSH and LH, not corresponding to a low concentration of sex steroids. Further there was a complete cessation of the secretion of FSH and LH with a simultaneous rapid decrease in the secretion of AMH. Given the small size of adenomas, in all cases selection of tactics for dynamic observation. All patients were prescribed hormone replacement therapy. Conclusion. For patients with premature ovarian failure, it is advisable to carry out MRI with contrast enhancement to exclude pituitary adenoma.
In this study we retrospectively analyzed data from 221 autopsy protocols of maternal mortality 1996-2015 years. Pathology of adrenal cortex detected in 11 dead. Microadenoma with or without adenomatous hyperplasia of adrenal cortex detected in 8 dead, simple hyperplasia detected in 3 dead. In one case detected bilateral diffuse nodular hyperplasia adrenal cortex in combination with focal adenomatous hyperplasia basophil adenocytes pituitary. In this article presented the background pathology analysis, course and outcomes of the last pregnancy. The conclusion was that the microadenomas of adrenal cortex rarely remain asymptomatic incidentalomas, but more often occur the subclinical or clinical hypercortisolism. The pregnancy on their background carries a high risk of developing of serious complications.
Purpose. To study the pharmacokinetics of -lactam antibiotics in the development of endometritis after cesarean section to select the optimal dosage regimen. Methods. A prospective, randomized, single-center study included 52 women in puerperas with endometritis after a caesarean section, divided into four groups. The patients of the first group (n = 17) received a course of ceftriaxone bolus in a single dose of 2.0 g (n = 10) and in the mode of prolonged perioperative infusion (n = 7). The patients of the second group (n = 10) received cefepim bolus at a dose of 2.0 g 2 times a day (n = 5) and in the extended infusion mode (n = 5). The patients of the third group (n = 14) received amoxicillin / clavulanic acid (Amoxiclav 1000 mg + 200 mg) bolus at a dose of 1.0 g 3 times a day (n = 7) and in the extended infusion regimen (n = 7). The patients of the fourth group (n = 11) received ampicillin / sulbactam (Ampisid 1000 mg + 500 mg) bolus at a dose of 1.0 g 4 times a day (n = 6) and in the extended infusion regimen (n = 5). We have compared the concentration of the studied antibiotics in the uterine cavity in the four groups using high performance liquid chromatography. Results. The effective bactericidal concentration (C 4MIC) was not maintained throughout the entire dose interval in any of the treatment groups. The clinical efficacy and safety of the studied antibiotic regimens were similar. However, prolonged infusion of cefepime and aminopenicillins provided significantly higher concentrations in lochia. Conclusion. Prolonged intravenous infusion of cefepime, ceftriaxone, amoxicillin / clavulanic acid and ampicillin / sulbactam in the treatment of endometritis after a caesarean section improves the pharmacokinetic / pharmacodynamic characteristics of these -lactams in the uterine cavity, compared with the traditional bolus administration.
BACKGROUND: In obstetrics, there are no systems or scales for assessing somatic burden, predicting and choosing empirical antibiotic therapy in postpartum (postoperative) pyoinflammatory complications. AIM: The given research aims to assess the reliability and validity of the Cumulative Illness Rating Scale for Obstetrics (CIRS-Obs), which has been firstly modified for obstetric patients. The study is based on the inclusion of additional variables that may be used as highly informative predictors of the development of infectious complications resistant to antibiotics following caesarean section to assess the prognosis. MATERIALS AND METHODS: A retrospective study of 406 clinical records of obstetric patients suffering endometritis following caesarean section and admitted to the Gynecology department of the Mariinskaya Municipal Hospital has been carried out during the period from September 2008 to September 2020. Multivariate regression analysis allowed to establish a number of indicators characterized by a high predictive value in relation to the unfavorable course of postpartum infections and the isolation of multidrug-resistant pathogens in patients with aggravated somatic status. The most significant factors have been included in the variant of the cumulative comorbidity index (CIRS-Obs), which was firstly modified by the authors for obstetric patients. RESULTS: The most significant predictors associated with a high risk of isolating resistant and multidrug-resistant pathogens in the examined patients suffering endometritis include CIRS score 4 points, an emergency caesarean section in combination with a prolonged labor and a period without amniotic fluid, antibiotic therapy in the third trimester of pregnancy, as well as previous hospitalizations during pregnancy/invasive procedures or operations. CONCLUSIONS: The CIRS-Obs scale modified for obstetric patients by including highly informative predictors and developed to assess the risk of isolating resistant and multi-resistant pathogens in obstetric patients suffering endometritis following cesarean section in terms of a patients somatic status, antibiotic therapy, the category of urgency and conditions of the operation allows to increase the reliability of the prognosis to make efficient therapeutic decisions.
The article discusses the principles of classification and therapy of gestosis and hypertension during pregnancy, and contains comments regarding the clinical Protocol published in 2012
A total of 64 artificial cycles with natural micronized progesterone replacement therapy were studied. Progesterone zoos used from day 4-5 before embryo transfer till gestational week 8-11 in different programmes (ovum/embryo donation, surrogacy, thawed embryos transfer after previous IVF/ICSI failures). Pregnancy rate was 43.5%. The HRT by natural micronized progesterone in artificial cycles could be stopped on gestational week 9 without any risk.
In this review, it is presented the importance for metabolic processes of decreasing estradiol concentration in connection with prolapsus of ovary function in women. Here, influence of different modes of substitute hormonal therapy, of different progestagenic components included in preparations is discussed.
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