Hypothesis/aims of study. The frequency of adverse intranatal outcomes is significantly increased when the pubic arch angle (PAA) is less than 90°. The accuracy of the manual method for determining PAA depends on a large number of parameters, such as obesity of a woman, as well as stereometric sensation and the experience of a doctor. Determination of PAA using ultrasound and X-ray pelviometry is generally available and reliable; however, it requires special training. The aim of this study was to develop mathematical methods for calculation of PAA. Study design, materials and methods. The study included a retrospective and prospective analysis of 120 birth histories based on the Regional Clinical Hospital Perinatal Center (the Chita city, the years 2017/2018), which were divided into three equal groups. Group 1 consisted of patients with body weight deficit, group 2 included patients with normal body mass index, and group 3 comprised patients with alimentary constitutional obesity. On the eve of the birth, external pelviometry, the manual method for determining PAA, and ultrasound pelviometry by translabial access were performed. Results. PAA determined by the manual method was 99.6 ± 11.3° in group 1, 100.1 ± 14.2° in group 2, and 98.2 ± 10.7° in group 3. When ultrasound pelviometry was performed, the value of PAA was 97.4 ± 10.7° in group 1, 104.8 ± 13.8° in group 2, and 104.1 ± 12.3° in group 3. The error of the manual method was 2.2% in group 1, 4.5% in group 2, and 7.6% in group 3. On the basis of mathematical modeling of external pelviometry data, a pattern is defined, which is expressed by the formula: PAA = 180° – arccos (0,5 ∙ S1S2/S1P) – arccos (0,5 ∙ B1B2/(B2S1 – S1P), where PAA is the pubic arch angle (°); S1S2, Distantia spinarum; S1P, the distance between the anterior superior spine of the ilium to the lower edge of the symphysis; B2S1, the distance between the anterior superior spine of the ilium to the tuberosity of the opposite ischium; B1B2, the transverse size of the output plane. The coefficient of determination (R-squared) is 0.82. Thus, mathematical modeling allows determining PAA with a high degree of reliability.
Amniotic fluid not only provides conditions for normal growth and development of the fetus, but also prevents umbilical cord compression and infection of the uterine cavity due to the existing bacteriostatic effect. In addition, amniotic fluid volume varies in pathological conditions of the fetus and the uteroplacental complex, which can lead to irreversible consequences. The aim of this study was to analyze features of assessing amniotic fluid volume at the present stage of development. In this review article, we analyzed, systematized, and summarized data obtained by foreign and domestic authors from 1980 to 2017. Reliable determination of amniotic fluid volume will optimize the management of pregnant women threatened by risk of perinatal pathology.
Reduction of perinatal morbidity and mortality is a priority task of medical obstetrics in the world. A significant role in the structure of perinatal mortality and morbidity has a clinically narrow pelvis. The incidence of clinically narrow pelvis in the world according to some authors is 1,4-8,5%, fetal-pelvic disproportion during labor of large fetus is 5,8-60 %. High rates of birth trauma (24-60%) as a result of fetal-pelvic disproportion determine the relevance of the study. The aim of the study was to define possibilities of diagnosis and prognosis fetal-pelvic disproportion at present stage.Materials. Literary data of foreign and domestic authors in the period from 1959 to 2016.Methods. Systematic review and synthesis of the literature data.Conclusion. It is necessary to determine an optimal algorithm for the diagnosis and prognosis fetal-pelvic disproportion, which will optimize the tactics of pregnancy and childbirth.
Students' participation in obstetrics and gynecology science studies and in skills competition influence on developing their skills («to learn», «to manage», «to master») is reviewed in this article. On the basis of the Department of Obstetrics and Gynecology of the Medical and Dental Faculties (Chita State Medical Academy) the effectiveness of the competency-based approach implementation in the active implementation framework of the Olympiad movement has been assessed. The first stage of the study included an knowledge's assessment of the 40 graduates of the Medical Faculty in 2019 with specialization in Obstetrics and Gynecology in accordance with the requirements of the Federal State Educational Standard 3+. The second stage of the study included an estimate the number of completed cases of the total number admitted to clinical residency at the Department of Obstetrics and Gynecology in period 2013-2019. Data resulting from the study: participation in obstetrics and gynecology science studies and in skills helps students to develop their higher level skills, to get a better idea about the Job, that will prevent occupational incompatible and professional burnout among future obstetriciangynecologists.
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