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During the first 4 weeks of gestation, the embryo is not yet differentiated and exposure to chemotherapy occurs the all-or-nothing principle. Most vulnerable to chemotherapy is the period from 5 to 10 weeks of pregnancy, the use of 1 cytostatic increases the risk of malformations in the hearth up to 10%, and a few - up to 25%. Prescription of therapy after 12 weeks is not associated with the risk of malformations. Development, but leads to delayed growth of the fetus and pancytopenia in newborns in 30%. Probability of a metostatic lesion the placenta and fetus is extremely low and is described primarily for hematogenous tumors. The course of treatment must be completed in 3 weeks. Before giving birth.

The article presents the algorithms of patient management, depending on the results of smear on oncology and in accordance with the age of the patient.

Progesterone-containing contraceptives do not have a significant impact on metabolic processes and can be prescribed to patients with systemic (diabetes mellitus, obesity) and other diseases. Desogestrel is a part of oral preparations in a dose of 75 mcg. The main mechanism of its contraceptive action is Suppression of ovulation (in 97% of cases). The frequency of pregnancy is 0.17 for 100 women-years. Progesterone-containing contraceptives should not be considered, as preparations of the second choice when deciding on the issue of family planning. According to the recommendations of the Center for Disease Control and Prevention organization of health, desogestrel is an acceptable contraceptive option for women with somatic diseases, defined tumor pathology and thrombotic states in the anamnesis.

The article is devoted to diagnostic methods, therapy possibilities and algorithms of management of patients with cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis is only valid during pregnancy. Shortening the length of the cervix

The article summarizes the results of numerous randomized studies and structured the approach to the tactics of managing patients with primary dysmenorrhea. The starting therapy is the administration of non-steroidal anti-inflammatory drugs and/or estrogen-progestational drugs. In the absence of the effect of therapy for 3 months, it is advisable to switch to a drug of another group or a combination of drugs. Failure to achieve the desired therapeutic result within 6 months is the basis for clarifying the diagnosis. The article is illustrated by the clinical case of a patient with primary dysmenorrhea.

Associated with pregnancy is breast cancer, which was first detected during pregnancy, during the first year after childbirth or at any time against lactation. Diagnosis of the disease in the first trimester is an indication for abortion. The detection of the disease after 20 weeks and the desire of the woman to maintain pregnancy is the basis for conducting a total mastectomy followed by polychemotherapy with doxorubicin with cyclophosphamide or with fluorouracil. Radiation therapy during pregnancy is not applied. The timing and method of delivery are determined individually and depend on the stage of the process and the period of pregnancy, when it was identified. A clinical case of a patient with edematous-infiltrative form of breast cancer of the IV stage, diagnosed for the first time in 22 weeks of pregnancy, is presented.

Genital herpes is a common disease diagnosed in 90% of people and is characterized by a recurring lifelong course. Clinical manifestations are diverse and manifest in 20% of infected people. The gold standard for diagnosis is the detection of virus culture and polymerase chain reaction in real time. Conducting oral antiviral therapy significantly reduces the duration, severity of the disease and the risk of infection of the sexual partner. At the initial episode of genital herpes it is necessary to carry out system antiviral therapy with its earliest start. The effectiveness of the use of acyclovir, valaciclovir and famciclovir is comparable, but only with valaciclovir the efficacy of two-fold daily dosing is proved. For patients with 6 or more episodes of exacerbations per year, suppressive therapy is indicated, the drug of choice is valaciclovir. With a relapse rate of less than 6 per year, it is sufficient to conduct episodic antiviral therapy. Clinical trials have demonstrated comparable efficacy of acyclovir, famciclovir and valaciclovir. The three-day course of valaciclovir (500 mg 2 times a day) is most suitable in view of the high bioavailability and rapid relief of viremia.

Connective tissue dysplasia is a genetically determined condition characterized by a violation of the structural organization and synthesis of the main components of connective tissue. The prevalence of non-syndromic forms is extremely high and to 46.6-72.0% is due to cofactor deficiency of magnesium. Typical obstetric complications in Ehlers-Danlos syndrome are bleeding, early formation of isthmicocervical insufficiciency, premature and rapid delivery, delayed fetal growth, symphysiopathy, rupture of the pubic joint, rupture of the perineum, spontaneous ruptures of the skin, vagina and internal organs, postpartum bleeding and incompetence of the pelvic floor muscles, bladder, urethra and rectum. Marfan syndrome in 40% of cases develop premature rupture of membranes, premature birth and miscarriage at an early age. Maternal mortality is 0.74 per 100 000 births and is associated with lamination (1%) or rupture of the aortic aneurysm (3%). With nonsynthetic forms of connective tissue dysplasia at the stage of pregravid preparation and throughout pregnancy, the appointment of magnesium preparations is indicated.

The article presents the latest data on the risks of complications development on the background of the use of combined oral contraceptives, as well as the treatment effects of the use of hormonal contraceptives.

The article presents current data on ovarian hyperstimulation syndrome. Classification, criteria for assessing the severity and in algorithmic form, see diagnostic and treat-ment approach to patients management. Separately theis sues of prevention of thromboembolic complications.

The prevalence and detection rate of tumors associated with pregnancy, is growing steadily. Detection of malignant neoplasms has always put the doctor before the need for a decision about the possibility and desirability of pregnancy. The fundamental issue is the nature and stage of pathologic process and duration of pregnancy. According to the Ministry of health and social development of the Russian Federation from December 3, 2007 N736 "On approval of the list of medical indications for artificial interruption of pregnancy", in the case of neoplasms that require chemotherapy or radiotherapy to the pelvic area when the code of the disease C51-58, shows the termination of pregnancy. In all other cases, the question of abortion is solved individually by the doctors. The article presents clinical cases of medical termination of pregnancy in patients with gestational age up to 20 weeks.

Great scientific and practical interest in the approach to therapy and prevention of isolated urogenital disorders caused by estrogen deficiency. Drug of choice for treating and preventing urogenital disorders is estrogenobuslovlennyh Ovestin containing estriol in sufficient therapeutic dosage. After the treatment course is shown the transition to supportive / preventive dose to prevent the resumption of symptoms. Climacteric syndrome with increasing life expectancy and the proportion of elderly in the population is a growing problem in women's health. Therapeutic and prophylactic approaches to urogenital disorders which were caused by estrogens deficit are present great interest. Ovestin containing estriol in sufficient therapeutic dosage is drug of choice for therapy and prevention of estrogen-related urogenital disorders. After the treatment course with Ovestin transition on supportive/ prophylactic dose is recommended for prevention of renewal of UGD symptoms.

A prospective, cohort study of the pregnancy and labor course in obese patients was carried out during the 2009 - 2011 period. Depending on the extent of obesity, all pregnant females were divided into three subgroups. The first subgroup comprised patients with grade I obesity (BMI - 30-34.9, n = 60), second group included patients with grade 2 obesity (BMI - 35-39.9, n = 28), and the third group included patients with grade 3 obesity (BMI - 40 and over, n = 12). All patients received complex clinical and laboratory examination. It was found that regardless of obesity grade, in the 3rd trimester every other patient develops gestosis, and every third patient develops threat of preterm labor. Females with grade 3 obesity are at a higher risk of development of not only complications of pregnancy, but also of unfavorable perinatal outcomes at that. These results and results of laboratory examinations confirm that obesity is the unfavorable background for pregnancy progression.

The article presents a literature review on methods of diagnosis, therapy and management of patients with isthmic-cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis can be made only during pregnancy. Shortening of cervical length

This article reviews the objectives of combination biochemical screening of unfavorable outcomes of pregnancy in trimester I. The characterization of prenatal screening markers is given, for example, β-hCG (beta-human chorionic gonadotropin) and РАРР-А (pregnancy-associated plasma protein A). The international and national approaches to the algorithm of carrying out of prenatal screening and conceptualization about prediction of pregnancy complications based on results of biochemical screening of serum concentrations of β-hCG and PAPP-A, are reviewed

The article presents the results of a prospective cohort study that investigated changes in principal components of the metabolic syndrome (MS) in women in the course of a pregnancy and an assessment of these components in the postnatal period. The presented study has demonstrated that the metabolic syndrome deteriorates the course of pregnancy. This condition is an indication for complex evaluation by physicians of various specialities, strict control of the metabolic profile, and early administration of renal protectors

Planning of a family and preservation of reproductive health - the important problem of modern medicine. According to recommendations the CART (1994) contraception is recommended to women up to menopaysa and absence menses in a current of year. In a kind of high risk of development or aggravation metabolic and hemostasies infringements for the purpose of hormonal contraception at women late reproductive period and perimenopaysa we had been used the microdosed out preparation Miniziston®20 Fem, containing 0,02 mg etynilestradiol and 0,1 mg levonorgestrel. Results of our research have shown that the given preparation has 100% contraceptive efficiency, provides necessary regulation of menstryal cycle, presence estrogen component promotes improvement of quality of a life of patients and knocking over of clinical symptoms, characteristic for the period perimenopaysa. Besides, Miniziston®20 Fem does not render clinically significant influence on metabolic an exchange and hemostasis system.

The article presents modern possibilities of the use of hormonal contraceptives in the form of combined estrogen-gestagenic agents, of gestagenic contraceptives, intrauterine equipment, implants and adhesive bandages. Discussedmainissuesof efficiency, safety and acceptability of the use of these funds in the high-risk group for the development of complications.

The paper presents the data of meta-analyses and individual randomized studies on the effectiveness of magnesium sulfate as a drug to reduce the risk of cerebral palsy in the development of premature birth.

The aim of the study was to investigate the effects of topical application of preparations containing glucocorticoids on the replicative activity of human papillomavirus oncogenic type. Prospective study included 160 patients of reproductive age. The examination included microbiological testing, qualitative and quantitative screening for human papilloma virus high-risk group (HPV-PCR and Digene-test), immunological study of cervical secret (immunoglobulins class A, M, G and secretory IgA). Was shown that the vaginal microbiocenosis in patients with nonspecific vaginitis presents a wide range of opportunistic microorganisms, such as Staphylococcus, Streptococcus, Peptostreptococcus, Bacteroides, Bacillus, Actinomyces, Corynebacterium, Prevotella. A number of typical representatives of the indigenous microflora is significantly reduced, or absent. The prevalence of concomitant viral infection was approximately 29%, the most frequently detected viruses 16, 31 and 18. The use of local therapy drug containing a glucocorticoid qualitative and quantitative changes in HPV have been no identified. Evaluation of indicators of local immunity showed an imbalance in the production of immunoglobulins with a predominance of IgA, secretory IgA and IgG in patients on the background of nonspecific vaginitis.

The article presents information on the possibilities for the cryopreservation of ovarian tissue with subsequent ortho - and heterotopic transplantation in patients receiving cytotoxic therapy.

This article provides information on acromegaly, highlighting the diagnostic algorithm of search and therapeutic tactics in detecting the disease in women of reproductive age. Based on the above clinical case described medical tactics in the management of pregnant women with acromegaly.

In the paper, we present a clinical case developed medicinal hepatitis described the tactics of management of the patient with the use of hepatic protectors.

A review of the literature dedicated to the state of knowledge of the problem of recurrent bacterial vaginosis, presents the modern theory of pathogenesis in terms of formation of microbial biofilms and Association of microorganisms.

Review of the literature devoted to the problem of early pregnancy losses. Presented modern classification, The etiology and pathogenesis of complications, diagnostic criteria and differential diagnosis, and treatment standards and opportunities for prevention.

Sexually transmitted infections (STIs) are a group of diseases for which sexual contact is the main route of transmission. At the moment there are more than 20 infections which spread through sexual contact. [2]

The following review is devoted to the problem of early pregnancy loss, the etiology and pathogenesis of this complication.

The study allowed to compare the clinical efficacy of the drug and antibiotic Terzhinan gynecological patients operated on for tubal peritoneal factor infertility. In women receiving traditional intraoperative antibiotic prophylaxis, the antimycotic treatment followed 2 weeks; after surgery the violation of the qualitative and quantitative composition of the microflora of the vagina was observed, which further required additional therapy. In patients who used Terzhinan, dysbiotic violations in the vagina were observed only in 2 women was a decrease in the number of representatives of the indigenous microflora. Thus, the local use of antibacterial drugs in the perioperative period can be considered as an alternative to the system or the single use of antibiotics, which allows to recommend their use in order to reduce the incidence of inflammatory and infectious diseases of the vagina in gynecological patients before and after surgery.

The paper presents a study of the safety and effectiveness of gestogen support of pregnancy in patients with metabolic syndrome. Efficacy of dydrogesterone in the development of the threat of termination in the first trimester has been demonstrated in 91% of patients with metabolic syndrome. Dydrogesterone use safety has been proven on the basis of no change in terms of the hemostatic system and components of lipid and carbohydrate metabolism.

Retrospective analysis of 400 pregnancy outcomes in obese women was performed. The risk of pregnancy complications was calculate The risk of pre-eclampsia in obese women elevated in 6,4 times, fetal growth restriction elevated in 4 times, urine infections and gestation pyelonephritis elevated in 1,5 times. For women with overweight, risk pre-eclampsia and hydramnion elevated in 5 and 7 times correspondingly.

We identified 158 patients with first-trimester PAPP-A and b-HCG < 5th centile. We excluded multiple pregnancies and major anomalies. 15,2% had evidence of fetal growth restriction and had significantly higher rates of gestational hypertension, preterm birth, low birth weight, 1-min Apgar score < 7, neonatal intensive care.

Одним из знаменательных событий нейроэндокринологии ХХ столетия явилось открытие двух групп ученых под руководством R.Guillemin и E.Shally. Им независимо друг от друга удалось расшифровать структуру гонадолиберина или гонадотропного рилизинг-гормона (ГНРГ). Впоследствии были изучены особенности пульсирующего ритма секреции ГНРГ и его стимулирующий эффект на секрецию фолликулостимулирующего (ФСГ) и лютеинизирующего (ЛГ) гормонов посредством рецепторов, расположенных на поверхности гонадотрофов аденогипофиза. Исследования последних лет позволили выявить рецепторы к ГНРГ в гранулезных клетках и в клетках поверхностного эпителия яичников. Описано влияние ГНРГ через рецепторные системы на стромальные клетки эндометрия и трофобласта. Практически одновременно были синтезированы аналоги ГНРГ, обладающие более высокой биологической активностью по сравнению с эндогенным соединением. Было показано, что агонисты ГНРГ способны стимулировать и/или длительно подавлять секрецию гонадотропных гормонов и овуляцию. Способность препаратов вызывать так называемую обратимую медикаментозную овариэктомию была рекомендована при заболеваниях, развивающихся под влиянием стероидных гормонов яичников. К основным направлениям медикаментозной терапии агонистами ГНРГ относятся: – подавление секреции стероидных гормонов, в частности эстрогенов, при таких заболеваниях, как рак предстательной железы, гормонально-зависимый рак молочных желез и эндометрия, эндометриоз, гиперплазия эндометрия и др.; – торможение гормональных механизмов, вызывающих преждевременное половое развитие у детей, – контроль и динамическое наблюдение за секрецией гонадотропных гормонов при стимуляции овуляции и суперовуляции в программе вспомогательных репродуктивных технологий, – применение препаратов, учитывая их локальный эффект на ткани, содержащие рецепторы к ГНРГ (некоторые виды опухолей, в частности миома матки). Одним из препаратов группы агонистов ГНРГ является Люкрин депо®. Действующее вещество данного препарата – лейпрорелина ацетат, заключен в стерильные микрогранулы (депо-форма). Эта депо-форма обеспечивает равномерное высвобождение лейпрорелина ацетата в течение 1 мес. Сразу же после введения депо-формы в течение 1–3 дней происходит резкое повышение концентрации ФСГ и ЛГ. Максимальный уровень гормонов регистрируется через 4 ч после введения Люкрин депо®. Постепенное снижение содержания гонадотропных гормонов ниже исходного уровня отмечается к концу 2-й недели лечения и сохраняется весь период назначения препарата. Яичники в течение первых дней также реагируют повышением концентрации эстрадиола, уровень которого постепенно снижается до уровня периода постменопаузы. Концентрация ингибина в ответ на введение Люкрин депо® снижается аналогично снижению уровня эстрогенов. Высокая концентрация препарата поддерживается наиболее длительно в плазме по сравнению с другими агонистами ГНРГ, что позволяет вводить Люкрин депо® в дозе 3,75 мг через 28–33 дня. Длительность терапии препаратом колеблется от 3 до 6 мес и зависит от гинекологической патологии и возраста пациентки. Временная лекарственная блокада аденогипофиза обратима и восстановление овуляции, менструально-репродуктивной функции, происходит в течение 1–1,5–2 мес после последней инъекции Люкрин депо®. Гинекологические заболевания, при которых применяется Люкрин депо®: генитальный эндометриоз, гиперпластические процессы эндометрия, программа экстракорпорального оплодотворения (ЭКО), подготовка пациенток с миомой матки к оперативному вмешательству.

The article presents a review of international literature on the possibilities of prevention of pre-eclampsia in women at high risk. Given data from recent randomized trials and meta-analyses, have confirmed whether the use of low-dose antiplatelet therapy with 12 weeks of pregnancy to prevent the development of pre-eclampsia.