Introduction. Pregnant women may be at increased risk for severe COVID-19 illness. Pregnant women are more likely to be hospitalized at ICU, needed the mechanical ventilation compared to nonpregnant women of childbearing age. Building on the experience of the effective use of the exogenous surfactant for influenza A/H1N1 treatment of pregnant women with COVID-19, the surfactant therapy has also been included in the treatment.The objective. To evaluate the effectiveness of surfactant therapy in the integrated treatment of severe COVID-19 pneumonia of pregnant women and postpartum women.Materials and methods. The study included 135 pregnant and postpartum women with severe COVID-19 pneumonia. All of them received antiviral, anticoagulant, anticytokine and anti-inflammatory therapy. 68 patients (main group) with an initially more severe course of the disease and a greater degree of lung damage (p = 0.026) received inhalations with Surfactant-BL, 67 patients (control group) did not receive the surfactant therapy. Patients received Surfactant-BL through a mesh-nebulizer at a dose of 75 mg 2 times a day for 3–5 days.Result. Patients of the main group showed decreasing risks of requiring the noninvasive ventilation (27.9% vs. 52.2%, р = 0.014) and artificial lung ventilation (2.9% vs. 11.9%, p = 0.047), the length of stay in the intensive care unit (ICU) was reduced (10.6 vs. 13.1 inpatient days, р = 0.045). Сomplications such as pneumomediastinum and pneumothorax occurred less frequently in the surfactant therapy group (24.2% vs. 52.4%, p = 0.037) with a high extent of lung damage (CT-3–4). With early surfactant therapy in the standard oxygen therapy stage or high-flow oxygenation, gas exchange indicators were restored faster, thus avoiding mechanical ventilation and has reduced the duration of intensive care (р = 0.004) and prevented deaths.Conclusion. The use of surfactant therapy for pneumonia associated with COVID-19 in pregnant and postpartum women against the background of ongoing complex therapy helps to prevent further lung damage, reduce the mechanical ventilation risk and improve oxygenation earlier, especially with early start of surfactant therapy.
Introduction. Loss of pregnancy remains an extremely acute public health problem today. Live birth accounts for only 30% of gestational outcomes, all other pregnancies that occur end in reproductive losses: 30% – implantation, 30% – postimplantation, 10% – spontaneous miscarriages. In conditions of declining birth rates, reducing reproductive losses is the most important element of the state’s demographic policy.Аim. Тo assess the reproductive health of women of fertile age in the Tyumen region, registered in antenatal clinics and other medical institutions in connection with pregnancy, as well as the risks associated with an increase in the frequency of diseases endemic for the West Siberian region.Materials and methods. The study used data from federal statistical observation. Statistical analysis of the data was carried out using the statistical program Statistica (version 13.0). Quantitative features are described by absolute and relative (percent) indicators. The difference is considered significant at p < 0.05. Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p >< 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 0.05.Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p < 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p < 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control.Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate.
Ectopic pregnancy is one of the most frequent and serious complications when using assisted reproductive technologies (ART). Difficulties in diagnosing ectopic pregnancy after ART are explained by atypical localization and ambiguous clinical picture. To analyze the clinical case of management and delivery of a pregnant woman words with twins when one of the fetuses is located in rudimentary horn. The retrospective analysis of anamnestic data, results of clinical and instrumental studies pregnant based on the exchange card of the pregnant woman and new mothers, birth history of the perinatal center of Tyumen. The clinical case of atypical placement of the fetus in the rudimentary horn in multiple pregnancies after ART is a fairly rare complication of the gestational period. Difficulties with timely diagnosis were associated with the lack of clear imaging during ultrasound examination. A timely diagnosis, in the current emergency situation, allowed the pregnancy to end favorably, both for the mother and for the fetus.
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