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Objectives - efficiency assessment of the dienogest (Visan^) in treatment of perimeopausal patients with adenomyosis and postmenopausal women, in whom the adenomyosis was newly diagnosed. Material and methods. Included in the study, there were 64 patients (aged 45-52 years) who had undergone the surgical treatment of adenomyosis followed by the dienogest treatment at a dose of 2 mg, and 47 women in the age of 54-57 years with newly diagnosed adenomyosis in the course of menopausal hormone therapy (MHT). All patients received 2 mg of dienogest (Visannе, Bayer) during the period of 3-6 months. Medical checkup was performed in 3 and 6 months after initiation of treatment. Results and Discussion. The remarkable reduction in clinical manifestations and improvement of uterine walls structure was registered in both groups of patients in 3 months of treatment. However, in 25% of patients the echographic changes remained significant. In 6 months all the patients had a sustained remission and amenorrhea. Conclusion. In the course of investigation the dienogest (Visan^) at a dose of 2 mg revealed high efficacy in treatment of endometriosis in late perimeopausal and postmeopausal patients with a diagnosed abnormal uterine bleeding associated with adenomyosis.

Objectives - to implement both a new clinical classification of chronic placental insufficiency (CPI) and a new complex rating scale based on calculation of an integral indicator of compensatory-adaptive placental reactions in order to improve perinatal outcomes. Material and methods. We examined 154 pregnant women with high risk of severe placental insufficiency (PI) in whom the markers of apoptosis, endothelial dysfunction, cell transformation and energy exchange were detected in gestation weeks 18-24 and 28-38 via blood analysis. It served the basis for development of the CPI severity rating scale. Diagnostic correlations in 359 pregnant women with various clinical and morphological manifestation of chronic PI allowed us to develop an original method of diagnosing the severity of this complication. Results and Discussion. The sequential changes in placenta in CPI ("placenta dysfunction" ^ "decompensated PI" ^ "progressive decompensated PI" ^ "acute PI") formed the basis of a new CPI clinical classification. The final indicator was calculated according to the complex point scale. The indicator's value from 1 to 3 points corresponds to placental dysfunction; the decompensated PI is diagnosed at 4 to 9 points; at 10 to 13 points - progressive decompensated PI; starting from 14 points - acute PI. The absence of PI is reported if the value of the final indicator scores zero. Conclusion. Setting a standard in the CPI diagnostic makes it 39% more accurate in severe PI, improves the perinatal outcomes by 60%, helps to avoid the disabling conditions in the neonates. High informativity and reliability of the developed PI severity rating diagnostic method was confirmed within the evidence-based medicine approach.

Aim - the purpose of the study is the development of a method for prevention of pathological pregnancy syndrome from the perspective of integral genesis, determined by morphological and functional abnormalities in the fetoplacental system, assessing the effectiveness of methodological standards of evidence-based medicine. Materials and methods. Prospective study of 435 women with high risk of decompensation of placental insufficiency was conducted. Depending on the method of prevention of gestational complications 4 groups were formed: 1st group included 145 pregnant women, who were prescribed dydrogesterone on the 6-20 weeks of gestation, and starting with the 21st week - highly-purified diosmin 600 mg as vasoprotective; in the 2nd group 118 women received a course of preventive treatment with low doses of acetylsalicylic acid; 3rd group included 102 patients who underwent a course of preventive monotherapy with magnesium; 4th group comprised 70 pregnant women who refused preventive treatment. A control group encompassed 30 healthy pregnant women. Dynamic survey included definition of markers of endothelial and hemostasiological dysfunction, vascular-platelet dysfunction elements, apoptosis, inflammatory response, total reactive capacity of the organism, magnesium and carbon dioxide concentrations; a hystostereometric study of placenta was conducted. Standards of evidence-based medicine were applied for the objectification of the effectiveness of the developed method. Results. Method of preventing great obstetric syndromes by successive appointment of progestogen dydrogesterone on the early stage of pregnancy followed by vasoprotective diosmin 600 mg in the 2nd half of pregnancy showed high efficiency (NNT 1.4 (95% CI 1.1 -1.7); OSH 5.3 (95% CI 4.7 -5.8), namely reducing pre-eclampsia by 93%, placental insufficiency with intrauterine growth restriction and/or chronic fetal hypoxia - 95%, preterm birth - 86%, and no premature abruption of normally situated placenta, severe forms of pre-eclampsia and placental insufficiency. Higher clinical effectiveness of the proposed method of prophylaxis of pathological pregnancy syndrome, compared to the use of low-dose acetylsalicylic acid and preparation of magnesium, can be explained by the normalizing effect of dydrogesterone and highly-purified diosmin 600 mg on the immune and biochemical homeostasis, apoptosis and angiogenesis, activation of endothelial and hemostasiological system, adaptive compensatory reactions in the placenta. Conclusion. The method of choice for the prevention of pathological pregnancy syndrome at high risk of fetoplacental system decompensation is the application of progestogen dydrogesterone and vasoprotective diosmin according to the developed method. The study revealed the potential of targeted selection of preventive methods depending on special needs of pregnant women.

Aim - allocation of clinical and pathogenetic variants of early gestosis in pregnant women based on clinical manifestations and markers of leading pathogenetic syndromes of gestational maladjustment. Materials and methods. 45 healthy pregnant women and 160 pregnant women with early morning sickness of varying severity were examined in the 1st trimester of gestation. The comparison group consisted of 33 healthy non-pregnant women. The survey included assessment of clinical symptoms, identification of the markers of inflammatory response, energy balance of reproductive system, functional activity of the endometrium, vascular endothelial and hemostatic disorders, and blood biochemical indices. Results. The study enabled quantitative objectivation of the factors of “physiological damage” and “the mechanisms of gestational adaptation” during physiological gestation, defining fetoplacental dysfunction as the key link of maladjustment in early pregnancy. The prevalence of pathogenetic mechanisms of the formation of early pregnancy toxicosis determined the allocation of 4 clinical-pathogenetic variants of the course of this complication of gestation. Conclusion. Differentiated approach to clinical and laboratory manifestations of early gestosis in pregnant women, taking into account the variants of the clinical course of this complication and severity assessment, enables targeted therapy and predicting the risk of development of severe forms and late obstetric complications, reduces the risk of adverse perinatal outcomes.