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Objective. To detect the incidence of congenital pneumonia in newborns from mothers with placental insufficiency in combination with premature amniotic fluid discharge Materials and methods. A retrospective analysis of 57 stories of newborn infants and their mothers was carried out. The newborns were divided into 3 groups: group 1 37 newborns from mothers with placental insufficiency and premature amniotic fluid discharge, group 2 9 infants from mothers with premature amniotic fluid discharge, group 3 11 infants born from mothers with placental insufficiency. The obstetric and gynecological history, the presence of extragenital pathology, the peculiarities of the course of pregnancy and childbirth, and the outcomes for newborns were analyzed. Results. Congenital pneumonia was more common in newborns from mothers with placental insufficiency and premature amniotic fluid discharge. In newborn infants of the first group, severe asphyxia occurred more often, being a risk factor. At the same time, the identification of markers of the systemic inflammatory reaction did not always reflect the presence of infectious-inflammatory pathology in newborns. In addition, in the presence of inflammation of the fetal part of placenta, in a large number of newborns pathological microflora is detected during microbiological examination. Conclusions. As a result of the study, the role of maternal pathology on the development of intrauterine infection and implementation of infection in the early neonatal period was revealed. The obtained data justify the need for pregravid preparation and prevention of perinatal complications in women with placental insufficiency.

BACKGROUND: The imbalance of vascular endothelial cell metabolism determines the clinical manifestations of preeclampsia; however, the molecular mechanisms underlying the vessel destabilization are not fully understood. In recent years, researchers have focused on clarifying the role of dysmetabolic disorders in patients with obstetric pathology, including preeclampsia. This is due to the fact that pregnancy is accompanied by metabolic restructuring aimed at switching the energy supply of the pregnant womans body from the carbohydrate to the fat component in order to maintain an effective energoplastic supply of the developing fetus. Impairment of this evolutionary adaptation mechanism realized during pregnancy requires additional in-depth study. AIM: This study was aimed to identify and compare pathogenetic patterns that characterize early and late preeclampsia at the preclinical stage, based on dynamic clinical and laboratory examination of high-risk pregnant women. MATERIALS AND METHODS: A prospective clinical and laboratory examination of 180 pregnant women with independent factors of high risk of developing preeclampsia was carried out. Comparison groups were identified retrospectively, depending on the period of preeclampsia manifestation: Group I consisted of 31 pregnant women with early preeclampsia; Group II comprised 58 pregnant women with late preeclampsia; and Group III (control) included 30 healthy pregnant women with uncomplicated gestation. Pregnant women were examined twice at the preclinical stage of preeclampsia (11-14 and 18-21 weeks of gestation) and once at clinical manifestation of the disease (28-36 weeks of gestation). The markers of metabolic, hormonal, hemocirculatory, hemostasiological and placental disorders were evaluated. RESULTS: We found similar pathophysiological changes in pregnant women with both early and late PE, from early gestation periods. Those were characterized by pathological insulin resistance and hyperinsulinemia, as well as associated atherogenic changes in the lipid profile, hyperleptinemia, hyperuricemia, hypersympathicotonia, visceral fat deposition, and contra-insular hormonal deviations. The observed alterations reflected a single hormonal and metabolic pattern of the preclinical stage of preeclampsia. During pregnancy, there was shown an increase in clustering diabetogenic and atherogenic abnormalities and hormonal changes, which were supplemented by associated endothelial and hemostasiological dysfunction and, in early preeclampsia, placental dysfunction, thus accelerating the time of clinical implementation of preeclampsia. CONCLUSIONS: From the pathogenetic point of view, preeclampsia of various periods of manifestation is an indivisible category with a common basic developmental mechanism characterized by a hormone metabolic pattern from the early stages of pregnancy. These stable changes are the result of the pathologically transformed phylogenetic mechanism of energoplastic supply of the fetus. This transformation is realized via physiological insulin resistance and compensatory hyperinsulinemia development due to the contra-insular activity of placental hormones. The added structural and functional disorders of the embryo (feto) placental system potentiate basic mechanisms (pathological insulin resistance and hyperinsulinemia) and determine the period of preeclampsia clinical manifestation in each particular woman.

The aim of the study was to show the effectiveness of treatment of acne with moderate severity in women with ovarian hyperandrogenism. A total of 25 female reproductive voerast patients with moderate acne and ovarian hyperandrogenism who were not planning pregnancy were examined. All patients were examined, which included a consultation with a gynecologist with a gynecological examination, ultrasound examination of the pelvic organs, a study of the hormonal status, a biochemical blood test, as well as a dermatological examination with the determination of the dermatological index of acne (DIA). After the examination, the patients underwent complex therapy using the external treatment recommended by the dermatovenerologist (skin cleansing, gel with azelaic acid and / or gel with adapalene), as well as the appointment of a combined oral contraceptive (COC) Jes Plus. Based on this study, it can be concluded that complex therapy, including local treatment and taking Jes Plus, is the first choice in the treatment of androgen-dependent dermopathy, manifested by moderate acne, in patients with ovarian hyperandrogenism due to PCOS. Such therapy contributes not only to the formation of a pronounced clinical result, but also causes a low probability of side effects. The administration of COC containing drospirenon and the active form of folate, in the form of the calcium salt levomefolate, allows a favorable effect on the metabolic processes in the body as a whole, and in particular, provides a positive effect on the skin, the cardiovascular system, reduces the risk of systemic and local inflammation, relieving the state of hyperhomocysteinemia, providing prevention of cardiometabolic risks.

Endometriosis refers to a chronic, often recurrent disease that requires the appointment of a long-term management plan and the patient with the appointment of therapy that effectively affects the clinic of this disease, at the same time having good tolerability, ensuring the patient's adherence to this method of treatment. This dictates the need for careful selection of a drug that meets such requirements. Moreover, studies of drug therapy for endometriosis should also be prolonged. In this case, they allow you to qualitatively assess the effectiveness of a particular type of treatment in the context of routine clinical practice. The main clinical manifestations of endometriosis of the uterine body-adenomyosis are pain syndrome, manifested by various types of pain (dysmenorrhea, dyspareunia, dyschesia, chronic pelvic pain) and the presence of abundant uterine bleeding. The presented clinical case demonstrates the effectiveness of long-term (for 36 months) use of dienogest at a dosage of 2 mg per day (the drug Vizanna) in a continuous mode in the treatment of a patient with adenomyosis. By the 4th month of therapy, the pain syndrome, manifested by dysmenorrhea and dyspareunia, which is the leading clinical manifestation of this pathology in the patient, was completely stopped. The proposed type of therapy has also demonstrated its effectiveness in relation to another clinical manifestation of the disease - heavy uterine bleeding. By the 6th month of therapy, the patient had developed persistent amenorrhea. Good tolerability and the absence of side effects, along with a pronounced clinical effect, led to a high adherence of the patient to this type of drug therapy and allowed her to continue it in the future with dynamic monitoring.

Introduction. Pre-eclampsia (PE) continues to be the leading problem in obstetrics. The existing methods for predicting PE show insufficient efficiency, and therefore the search for new predictors of PE remains relevant.The goal of the study. To develop a method for staged stratification of pregnant women to the risk of PE according on the basis of the revealed dismetabolic features of the pathogenesis of this complication of gestation.Material and methods. A dynamic clinical and laboratory examination of 180 pregnant women with independent factors of high risk of PE was carried out. PE was revealed in 89 women who made up group I. Group II (control) consisted of 30 healthy pregnant women with the physiological gestation.Results and discussion. A statistically significant increase in diabetogenic and atherogenic changes characteristic of physiological pregnancy, changes in hormonal, endothelial-hemostasiological, pro-inflammatory and placental parameters aimed at the energy and plastic supply of the fetus was revealed in women with PE. The results of laboratory examination, statistical data processing showed that the most significant pathogenetic mechanisms of development of PE are pathological insulin resistance (IR) and hyperinsulinemia (HI), which act as the basic link and initiate atherogenic transformation of the lipid profile, pro-inflammatory and immunometabolic disorders, prothrombotic status, hyperleptinemia, hyperuricemia, antiangiogenic state and endothelial dysfunction, which indicates a pronounced pathogenetic and clinical similarity of PE and metabolic syndrome. The revealed features of the pathogenesis of PE were reflected in the method of staged risk stratification of pregnant women: the models for assessing the individual risk of PE implementation included the levels of insulin, PlGF, PAMG-1, and TNF-α at 11–14 weeks of gestation; levels of insulin, uric acid, TNF-α, and mean platelet volume at 18-21 weeks of gestation (I trimester – AUC = 0.886, Se = 86.7%, Sp = 84.3%; II trimester - AUC = 0.874, Se = 83.3%, Sp = 87.2%, р < 0.001).Conclusion. Practical application of the developed pathogenetically substantiated method of staged stratification of pregnant women by the risk of PE implementation will justify the appointment and enhancement of preventive measures, reduce the incidence of severe and complicated forms of PE, and improve gestational and perinatal outcomes.

Genital endometriosis is a disease of women of reproductive age, accompanied by infertility in 50% [1]. Adenomyosis can be considered as an endometriosis of the uterus. Histologically, this process is represented by ectopic, non-tumor endometrial glands, and stroma surrounded by hypertrophic and hyperplastic myometrium [2]. Adenomyosis is accompanied by pelvic pain of varying intensity as well as menstrual disorders [1]. The disease is accompanied by significant violations of reproductive function (infertility, unsuccessful attempts at pregnancy and miscarriage, abnormal uterine bleeding). Adenomyosis can be accompanied by a violation of the function of adjacent organs (such as the bladder, rectum). Often, one of the clinical manifestations of adenomyosis is the development of sideropenic syndrome, which is also caused by the development of chronic post-hemorrhagic iron deficiency anemia. This is accompanied by a deterioration in the general condition of patients, a decrease in their ability to work. Despite a large number of publications in Russian and foreign scientific sources devoted to this problem, reproductive doctors and obstetricians-gynecologists often underestimate the role of adenomyosis in pregnancy planning using assisted reproductive technologies. Without interpreting the anamnesis data obtained through an active survey, doctors do not prescribe additional methods for diagnosing this pathology, which is not complex and expensive. To confirm the diagnosis, a transvaginal ultrasound examination of the pelvic organs during the premenstrual period is sufficient. In cases that are difficult to diagnose, the MRI method of the corresponding anatomical area can be used. Underestimation of the clinical picture and under-examination of the patient did not allow prescribing timely correction of the pathology and led to unsuccessful attempts to implement the generative function using assisted reproductive technologies. The conducted examination with clarification of the cause of IVF failures and the prescribed reasonable treatment made it possible to achieve regression of endometriosis foci in this clinical situation, followed by the patient's ability to realize generative function.

In modern obstetrics, an abnormal placental invasion is a serious problem associated with the following high perinatal losses: massive obstetric bleeding that leads to the death of both the mother and the fetus. Objective. The purpose of the study was to analyze the methods of delivery in patients with placenta accreta. Materials and methods. The study group consisted of 31 patients aged 25 to 42 years with placenta ingrowth, who underwent metroplasty in the Perinatal Center of V. D. Seredavin Samara Regional Clinical Hospital in the period from May 2018 to December 2019. Most often, placental ingrowth was detected in the second trimester of pregnancy (41.94 %). In 5 cases, placental ingrowth was diagnosed in the operating room (16.3 %). On average, the time of detection of ingrowth is 24.96 weeks of gestation. Results. Out of 31 patients we observed, 27 underwent metroplasty using complex compression hemostasis, and 1 patient underwent temporary balloon occlusion of the internal iliac arteries. The total volume of blood loss was 1625 485 ml, and the median was 1455 ml. Only 5 (17.24 %) patients had a blood loss of more than 2000 ml, and there was no blood loss of more than 3000 ml. Conclusions. Introduction of organ-preserving operations allows maintaining a woman's reproductive health, avoiding massive blood loss, and improving perinatal outcomes. Patients with a scar on the uterus after cesarean section, with placentation on the anterior wall and in the area of the scar on the uterus should be immediately sent to the third level of rendering specialized medical care.

Aim. To confirm that dysbiosis of the urinary tract or gut may be associated with endometriosis course. Materials and methods. We analyzed the samples of vaginal, cervical and intestinal epithelial cell scrapes in 32 patients with a confirmed intraoperative diagnosis of stage III and IV endometriosis and 25 healthy patients as a control group. A wide range of pathogenic and opportunistic microorganisms was evaluated using polymerase-chain reaction (PCR) method to determine real-time results. We found fundamental differences between the samples of microflora in the investigated group and the control group. The lack of opportunistic gram-positive Atopobium vaginae in the vaginal and cervical secretions of women with stage IIIIV endometriosis was statistically significant (p 0.05). In the samples of cervical canal of epithelial scrapes of patients with stage IIIIV endometriosis, there were detected clinically significant amounts (more than 104 million copies of DNA/ml) of opportunistic and pathogenic microorganisms Gardnerella vaginalis, Porphimonas spp. Opportunistic strains Gardnerella vaginalis, Prevotella bivia, Escherichia colli, Streptococcus spp. dominated in the rectal scrapes of the patients of the investigated group. On the basis of the obtained data of microbiota studying, individual correction of the detected dysbiosis was carried out. Results. The obtained data demonstrated an altered microflora of the urogenital tract and gut in patients with stage III and IV endometriosis. After therapy, the groups ceased to differ in the frequency of detection of normocenosis, moderate dysbiosis and severe dysbiosis that testifies to the normalization of urogenital tract and intestinal microflora in patients with moderate and severe courses of ovarian endometriosis. Further research is needed to examine whether dysbiosis is a consequence of the development of moderate and severe endometriosis or dysbiosis is a concomitant background pathology that contributes to the formation of endometriosis of this degree of severity.

Purpose. To identify the effects of gestational iron deficiency anemia after treatment with iron-containing drugs during the perinatal period on the health status of full-term children during their 1st year of life.Patients and methods.The authors carried out a prospective observational cohort study of full-term infants of I & II health group from their birth to twelve months. The course of pregnancy and labor was analyzed retrospectively. Hemoglobin, serum ferritin and C-reactive protein were measured in the six and twelve months old children and their mothers in 6 months after giving birth. We examined 140 couples of mother-child with gestational anemia (Group 1) and 166 couples without anemia during pregnancy (Group 2) in 6 months after giving birth, and in 12 months – 103 and 131 couples respectively. All women with iron deficiency anemia (Group 1) received therapy during pregnancy. Results. Gestational anemia is associated with threatened miscarriage (Odds Ratio (OR) 3.496; 95% CI 2.013–6.072), chronic placental insufficiency (OR 1.907; 95% CI 1.025–3.548), delivery by cesarean section (OR 2.729; 95% CI 1.651–4.502), increased infectious morbidity in pregnant women (OR 1.079; 95% CI 1.025–3.548) and insufficient lactation (OR 1.990; 95% CI 1.209– 3.277). Treated anemia during pregnancy is not associated with low birth weight and low weight of 6 and 12 months old children. 8.6% of 6 months old children suffered from iron deficiency anemia, which is two times lower than in the group without anemia (p=0.007). The frequency of iron deficiency anemia did not differ in 12 months old children (р=0.543). Conclusion: Iron supplementation reduces the negative impact of anemia on child’s health, including anthropometric indicators, iron stores, and risk of infectious diseases. The indirect effect is maintained through the adverse course of the perinatal period and the low duration of lactation.

Background. Exposure to physical and chemical work-related hazards can lead to an impairment of reproductive function, gynecological diseases and a pregnancy course worsening. Aim to determine methods of prevention and treatment of occupational disorders of the reproductive system in women and men who deals with harmful labour conditions. Outcomes and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-15 years was conducted. The review includes articles from peer-reviewed literature. Results. Evaluation of a relationship and its degree between a reproductive system diseases and workplace conditions showed that women working in harmful conditions (class 3.1-3.3) had complications of pregnancy and childbirth disorders which were to a high or medium degree related to their labour conditions. Newborns’ health disorders were assessed as a category of very high degree relationships with the mother’s work. Thus the fact that maternal occupational risks induce a child’s health disorders can be considered as fundamentally proven. This study data showed that occupations of high risk of a reproductive health disorders include female workers who work in conditions of class 3 of the 2nd degree of harm. Conclusions. Obstetrician-gynecologists, occupational physicians who work as part of medical commissions for preliminary and periodic medical examinations as well as obstetrician-gynecologists who deals with women of reproductive age in women’s consultation clinic and reproductive health centers (including those planning childbearing) need to make decisions strictly according to legal and regulatory acts on health protection of employees who work under arduous and harmful labour conditions, and above all to consider on maintenance of their reproductive function.

The Objective of this article is to assess the influence of the factors of pregnancy, childbirth and the early neonatal period on the development of acute kidney damage in premature newborns with very low and extremely low body weight. In addition, this disease significantly affects the prognosis and quality of life of the child. In addition, acute kidney damage significantly increases mortality among patients of the intensive care unit for newborns. There has been established a connection between acute hypoxia in childbirth, extremely low body weight at birth, intrauterine infection and III severity on the NTISS scale with the development of acute kidney damage in the early neonatal period. Early detection of this condition requires a comprehensive study of the mechanisms of its development and possible risk factors.

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.

The main goal of treating couples with infertility is achieving pregnancy and successful delivery of the newborn. Laparoscopy is used worldwide for treating patients with infertility due to endometriosis or recurrent functional uni- or bilateral ovarian cysts. In our prospective study we examined 258 women with the diagnosis of benign mass of the ovaries who underwent treatment for infertility at Samara State Clinical Hospital n.a. V.D. Seredavin within the period from November 2015 to December 2017. 54 women with infertility were enrolled in the current study. We divided them into two groups: the first group included patients with endometrioid cysts (n = 20) and the second one included patients diagnosed with functionalovarian cysts (n = 34). Exclusion criteria comprised the tubal factor of infertility, male factor, BMI > 25 of female and other metabolic disorders. Anti-Mullerian hormone (AMH) ng/ml and CA-125 were determined preoperatively. Patients were compatible with age, parity, and duration of infertility. Post-operative levels of AMH were measured on the first cycle after surgery. Postoperatively the patients were followed up for 6 monthsin order to confirm the presence/absence of pregnancy by ultrasound examination and the level of human chorionic gonadotropin in blood. 42,6% of total women enrolled in this study became pregnant within 6 months after surgery. The proportion of pregnancies in the group with treated endometriomas was significantly lower in comparison with the group of functional cysts: 7 patients (35%)in the first groupand 16 patients (47,05%) in the second one, p < 0.007 respectively. We consider post-operative AMH level to be more accurate prognostic tool for predicting results of laparoscopic infertility treatment in women both with ovarian cysts and endometriomas.

Introduction. Based on the knowledge of early gestational disorders related to metabolic syndrome (MS), pathogenetically relevant preventive treatment meeting the requirements of perinatal pharmacology can be developed. Aim. To reveal clinical and laboratory characteristics of early pregnancy and develop pathogenetically relevant preventive monotherapy for unfavorable gestational and perinatal outcomes in women with metabolic syndrome. Material and methods. A total of 230 women were investigated and divided into four groups: Group I consisted of 68 pregnant women with MS who refused any preventive measures; Group II comprised 97 women with MS who received periconceptional preventive monotherapy with dydrogesterone, a progestagen; Group III consisted of 35 healthy primigravidas women with physiological course of gestation; Group IV comprised 30 healthy non-pregnant women. Laboratory testing during IIII trimesters allowed to assess the dynamics demonstrated by markers of lipid spectrum, endothelial dysfunction, apoptosis, decidualization, energy metabolism, and immunomodulation. Results. A balance between factors of physiological damage and gestational adaptation in the course of physiological pregnancy has been shown to be of primary significance. In women with MS, embryo-placental dysfunction develops during early pregnancy, and this stage is preceding for major obstetric syndromes. Preventive administration of dydrogesterone in women with MS appeared highly effective: NNT (number needed to treat) was 1.33 (95% CI 0.91.8); OR 5.2 (95% CI 4.65.7). Conclusion. Pregestational changes and atherogenic profile of gestational process determine the course of early pregnancy in women with MS with the development of embryo-placental dysfunction and major obstetric syndromes. High efficacy in the prevention of unfavorable gestational and perinatal outcomes was shown by preventive dydrogesterone monotherapy.

The aim of the study was to classify clinical and pathogenetic variants of early toxicosis in pregnant women based on clinical manifestations and markers of gestational maladaptation. Materials and methods. In the first trimester of gestation, 45 healthy pregnant women and 160 pregnant women with early toxicosis of varying severity were examined. The comparison group was comprised of 33 healthy non-pregnant women. In addition to the clinical symptoms, a number of laboratory markers were measured. Those included the indicators of inflammation, energy balance of the reproductive system, endometrial functional activity, vascular endothelial and hemostatic disorders, as well as blood biochemistry. Results. The obtained data were used to quantify the factors of "physiological damage" and "mechanisms of gestational adaptation" in the case of physiological gestation, and to identify the embryo-placental dysfunction as a major mechanism of maladaptation in the early stages of pregnancy. The results allowed us to propose four clinical and pathogenetic variants of early toxicosis. Conclusion. The suggested selective approach to clinical and laboratory manifestations of early toxicosis based on its classification and severity, makes it possible to rationalize the therapy, predict the risk of severe and late obstetrical complications, and reduce the risk of adverse perinatal outcomes.

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.

The book contains 235 eponymous symptoms and samples, 163 syndromes and diseases related to obstetrics and gynecology. The publication consists of two parts, the first part refers to the semiotics of gynecological diseases and presents symptoms and signs. The second part includes nosological units and symptom complexes, which are systematized in alphabetical order. Their explanation, historical information, data on disease epidemiology, etiology, pathogenesis and clinical picture are presented. From the standpoint of modern evidence-based medicine provides information on the diagnosis, treatment and prevention of major diseases encountered in the practice of obstetrician-gynecologist. It is intended for students of medical universities as information about the meaning of eponymous terms that they face in the process of learning, practical work and in the study of special medical literature. It will be useful to researchers, teachers of higher medical school, obstetricians and gynecologists.

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.

To assess the long-term clinical results of vaccination with pneumococcal polysaccharide and conjugated polysaccharide vaccines in the separate and sequential use, by determining the optimal vaccination schedule in adult patients with chronic obstructive pulmonary disease (COPD) and to investigate adaptive immunity levels.The clinical effects of vaccination were evaluated in patients with COPD within 1 and 4 years after immunization against pneumococcal infection using various schemes, as well as the time course of changes in adaptive immunity indicators was examined.Four years after vaccination, the 13-valent pneumococcal conjugate vaccine (PCV13)/23-valent pneumococcal polysaccharide vaccine (PPV23) group showed a decline in the number of patients with COPD exacerbations by 50% (p0.001) and reductions in the number of antimicrobial chemotherapy cycles by 47.8% (p0.001) and in that of hospitalizations by 87.5% (p0.001). At 1 year after vaccination versus at baseline, the COPD patients vaccinated against pneumococcal disease, regardless of the drug and schedule of vaccination, displayed elevated levels of IgG antibodies to the mixture of capsular polysaccharides included in PPV23 and PCV13.It has been indicated that a complex of basic therapy for patients with COPD should include initial vaccination with PCV13, followed by administration of a booster dose of PPV23.Цель исследования. Оценка отдаленных клинических результатов вакцинации пневмококковыми полисахаридной и конъюгированной полисахаридной вакцинами при раздельном и последовательном применении с определением оптимальной схемы вакцинации у взрослых больных хронической обструктивной болезнью легких (ХОБЛ); изучение уровней адаптивного иммунитета. Материалы и методы. Проведена оценка клинических эффектов вакцинации у больных ХОБЛ в течение 1-го и 4-го годов после иммунизации против пневмококковой инфекции с использованием различных схем, а также изучена динамика показателей адаптивного иммунитета. Результаты. Через 4 года после вакцинации в группе 13-валентной пневмококковой конъюгированной вакцины (ПКВ13)/23-валентной пневмококковой полисахаридной вакцины (ППВ23) уменьшилось число пациентов с обострениями ХОБЛ на 50% (р0,001), число курсов антибактериальных химиопрепаратов - на 47,8% (р0,001), число госпитализаций - на 87,5% (р0,001). Установлено увеличение уровня IgG-антител к смеси капсульных полисахаридов, входящих в состав ППВ23 и ПКВ13, через год после вакцинации по сравнению с исходным у больных ХОБЛ, вакцинированных против пневмококковой инфекции, вне зависимости от используемого препарата и схемы введения. Заключение. Пациентам с ХОБЛ показано введение в комплекс базисной терапии первоначальной вакцинации ПКВ13 с последующим введением бустер-дозы ППВ23.

To evaluate the effectiveness of combined use of the imiquimod 5% cream and vaccination against human papillomavirus (HPV) using a quadrivalent recombinant vaccine to achieve long-term clinical remission of chronic HPV infection manifested by anogenital warts.The study comprised 36 patients, including 22 men, aged 26.4+/-4.1 years, who had from 1 to 5 anogenital warts. Participants of the study were vaccinated by quadrivalent recombinant vaccine under a 3-dose scheme 0-2-6 months co-administered with imiquimod 5% cream three times per week up to 16 weeks. The follow-up period was 2 years.Complete disappearance of genital warts within 1 year from baseline was observed in 34 (94.4%) patients. Two patients with anogenital warts after 1 year were treated for 1 year 3 months and 1 year and 4 months with Solcoderm which lead to the complete disappearance of genital warts. There were no recurrences of genital warts during the 2 years of follow-up.Vaccination with a recombinant quadrivalent vaccine concurrently with using imiquimod 5% cream results in prolonged clinical remission of chronic HPV infection manifested by anogenital warts in at least 94.4% of the cases (2 year follow-up).

The homotoxicology and antihomotoxic therapy are a relatively new branches in medicine involving an alternative approach to allopathic treatment. A holistic approach to treating a patient on the basis of the principles of homotoxicology implements in practice the provision “not to treat a disease, treat the patient”. Unlike allopathic medicines, most antihomotoxic drugs don’t have embryotoxic, teratogenic, mutagenic and phetotoxic effects, don’t cause a drug addiction and drug dependencies due to the content of active substances of plant, animal, mineral origin. This is widely applying them in obstetric and pediatric practice. Antihomotoxic therapy has the following advantages: minimum of contra-indications and adverse reactions, regulative principle effects on the body, nosologic approach to the prescription, synergistic effect with traditional medicines, reduction polypharmacy that allow to use this therapy in all directions of medicine and create prerequisites for the study of new methods of treatment and prevention for many diseases. Antihomotoxic therapy contributes to the activation the body´s internal reserves, the regulation of various systems and promotes long-term effect of the treatment. In numerous studies to assess the effectiveness of antihomotoxic therapy in the treatment of diseases of the reproductive system, in neonatal practices noted that the best results are achieved when antihomotoxic drugs are used in the complex treatment. However, on the background of a considerable increase of the effectiveness of the sharp decrease in the frequency of side effects of allopathic medicines noted. This review presents the main provisions homotoxicologic and successfully applied methods of antihomotoxic therapy in obstetrics, gynecology and neonatology.

Previously [1, 2] we synthesized a series of azolides of aliphatic and aromatic sulfonic acids and studied their immunomodulant and cytoprotector properties. In continuation of that work, we have synthesized a series of new aliphatic and aromatic sulfonic acid azolides and evaluated the products with respect to biological activity. The new series includes 2-benzotriazolide (I) and benzimidazolide (II) of methanesulfonic acid and 1,2,4-triazolide (III) and imidazolide (IV) of benzenesulfonic acid. The initial compounds were chloroanhydrides of the sulfonic acids and the corresponding nitrogen-containing heterocycles: imidazole, 1,2,4-triazole, benzimidazole, and benzotriazole. The reactions were conducted at room temperature in anhydrous ether or anhydrous chloroform in the presence of triethylamine.