The article presents organization of three-level system of obstetrics service in rural region with large territory and lower population density (the Altai Krai) in actual conditions. The dynamic analysis of indices of maternal and perinatal mortality in 2007-2016 was implemented on the basis of evaluation of efficiency of implemented innovative informative technology "The Register of Pregnant Women". The priority directions of functioning of service are family planning and reproductive health care, safe maternity, perinatal care of fetus and newborn.
The aim of this study was to determine reference values of matrix metalloproteinase-1 (MMP-1), MMP-2, MMP-9 and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) in the amniotic fluid at the first stage of labor in physiological pregnancy. 89 women at the first stage of term labor have been examined. Samples of amniotic fluid were taken at the first period of labor by vaginal amniotomy. Concentrations ofMMP-1, MMP-2, MMP-9, and TIMP-1 were investigated in amniotic fluid by ELISA kits. We have determined normal concentration ranges for MMP-1, MMP-2, MMP-9, TIMP-1, and ratios of concentrations of MMPs and TIMP-1 (MMP-1/TIMP-1, MMP-2/TIMP-1, MMP-9/TIMP-1) in the amniotic fluid at the first period of labor in physiological pregnancy. These included: MMP-1 - 5.1-16.8 pg/mg of protein, MMP-2 - 238.3-374.1 pg/mg of protein, MMP-9 - 66.1-113.3 pg/mg of protein, TIMP-1 - 4.7-13.6 pg/mg of protein, ratio of MMP-1/TIMP-1 - 0.1-2.2, ratio of MMP-2/TIMP-1 - 19.9-55.7, ratio of MMP-9/TIMP-1 - 4.2-17.2.
Objective. To determine the clinical and metabolic changes in children born from mothers with gestational diabetes mellitus and to predict perinatal injury of the central nervous system (CNS), taking into account the level of maternal hyperglycemia.Material and methods. The period of early postnatal adaptation was analyzed in 258 full-term infants, who were divided into two groups, depending on the glucose level in the mother’s venous blood during pregnancy: Group 1: 5,1–5,6 mmol/L, Group 2: 5,7–7,0 mmol/L.Results. Based on clinical, functional and laboratory markers (electrolyte balance and carbohydrate metabolism in the blood of a newborn) there was established a correlation between the severity of maternal hyperglycemia and the severity of neonatal disorders. In Group II infants born from mothers with more severe hyperglycemia are more likely to have a respiratory distress syndrome and ischemic-hypoxic injury of the central nervous system in combination with excess birth weight which significantly complicates postnatal adaptation.Conclusion. The concentration of neuron-specific enolase of 4,9 ng/ml in the fetal amniotic fluid is an antenatal marker of perinatal damage to the central nervous system in a newborn.
Aim: to identify the risk factors for gestational diabetes mellitus (GDМ) and predictors of perinatal lesions of central nervous system (CNS) combined with GDМ and maternal obesity.Materials and Methods. А retrospective observational case-control non-combined study was conducted to determine GDМ risk factors and their effect on perinatal pathology in 250 women divided into 2 groups. The main group included 150 pregnant women diagnosed with GDМ, the control group – 100 pregnant women without carbohydrate metabolism disorders. An assessment of hereditary, obstetric and gynecological history, as well as somatic health was carried out. Patients from the main group were subdivided into smaller groups: 1А (n = 77) – mothers whose newborns postnatally exerted adverse perinatal outcomes associated with impacting maternal hyperglycemia, and 1В (n = 73) – mothers whose newborns were born healthy. CHAID method (Chi Squared Automatic Interaction Detection) was used to create an algorithm for predicting adverse perinatal outcomes in GDМ. Аt the second stage, a single-center prospective observational non-combined cohort study was conducted to assess an effect of maternal hyperglycemia on formation of perinatal CNS lesions. Pre-labor concentration of neuron-specific enolase (NSE) was measured in the amniotic fluid of full-term fetuses in the group of pregnant women with GDM (n = 33) and in the group of pregnant women lacking carbohydrate metabolism disorders (n = 42).Results. Obesity, late reproductive age, family history of type 2 diabetes mellitus, abortions, early reproductive losses, macrosomic delivery in history are the main risk factors for GDM development. An algorithm was developed that allowed to predict a risk of newborn perinatal pathology in mother with GDM with an overall percentage of correct predictions of 68.7 ± 3.8 %. Pre-labor concentration of NSE in the amniotic fluid of full-term fetuses was elevated by 1.68 times (p = 0.006) in women with combined GDM and obesity (5.56 [3.37–6.24] ng/ml) compared to pregnant women with normal weight lacking carbohydrate metabolism disorders (3.29 [1.49–4.89] ng/ml).Conclusion. Pregnant women with obesity and type 2 diabetes mellitus familial history were featured with most prominent potential of developing perinatal complications. Rise in amniotic fluid NSE level in patients with GDМ corroborates damage of fetal CNS during antenatal period. The maximum NSE level was found in women comorbid with GDM and obesity.
Here we review the recent literature on pelvic floor dysfunction, which is increasingly common in women of reproductive age and represents a significant medical problem occurring as a result of injured pelvic floor ligaments. Pelvic floor dysfunction is largely associated with vaginal delivery and might lead to urinary and fecal incontinence as well as pelvic organ prolapse. Intraabdominal hypertension, nerve damage, obesity, and genetic predisposition are among the major contributors to pelvic floor dysfunction. Being asymptomatic at the early stage, pelvic floor dysfunction gradually leads to the irreversible alterations in pelvic floor anatomy, ultimately deteriorating quality of life. Surgery remains a gold standard in the treatment of pelvic organ prolapse, yet POP-Q stage I-II prolapse should be treated conservatively. Currently, there are no specific treatment regimens and no evidence-based opinion regarding Kegel exercises and laser therapy. Biofeedback pelvic floor muscle training is the treatment of choice for urinary incontinence. Use of pessaries represents another efficient approach to conservative treatment.
The aim of the research is to assess the epidemiology of premature birth and measures for organizing medical evacuation of patients from agricultural regions in vast territory of the Tyva Republic and Altay Territory for the period 2015-2019. Material and methods. Th e statistical reports data on the work of obstetric service in the Tyva Republic and Altay Territory for the period 2015-2019 are analyzed. Th e frequency, structure, dynamics of premature birth, features of organizing medical evacuation have been studied. Th e analysis of the information received was carried out using absolute, relative and intensive fi gures. Th e statistical signifi cance of the temporal dynamics of data was assessed using regression analysis with calculation of determination coefficient. Results. The analysis showed that premature birth frequency in two agricultural regions with a vast territory and diff erent nationalities in the Tyva Republic and Altay Territory over the past 5 years has no tendency to decrease (2019 – 6.2 % and 7.1 %, respectively) and the data are comparable with an average Russian indicator (2018 - 6.0 %). Distribution of PB by clinical phenotype and gestational age in the studied territories does not diff er and correspond to global indicators. Th e share of very early premature births (22-27 weeks of gestation) is not more than 7 %. A distinctive feature of Altai Territory in comparison with the Tyva Republic is a rarer (p <0.001) obstetric delivery of patients with PB in obstetric hospitals, level III (63.3 % and 96.8 %, respectively), which is associated with high frequency of late PB (53.1 %) and suffi cient capacity of medical organizations, level II. During medical evacuation in the regions, beta-adrenergic agonist ginipral (95 %) was used for acute tocolysis. Conclusion. Organization of medical evacuation in the Tyva Republic is characterized by more frequent use of air ambulance for patient transportation to obstetric hospital, level III, which is explainable by 7 times lower population density compared to Altay Territory with the same schemes of acute tocolysis.
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