Search

Objective: evaluation of the efficacy and safety of the use of probiotic Vagilac® in the prevention and treatment of vaginal dysbiosis in pregnancy.Material and methods: 140 pregnant women admitted to the Obstetric Probationary Ward of Moscow Regional Research Institute of Obstetrics and Gynecology of the Ministry of Health of Moscow at 36–39 weeks of gestation were examined and treated. All patients underwent complex clinical and laboratory examination. The patients were divided into 2 groups: I – 60 pregnant women with the established diagnosis of «bacterial vaginosis» (BV) and II – 80 pregnant women, who received antibacterial therapy due to exacerbation of infectious extragenital diseases. Of 140 pregnant women, 100 (60 from Group I and 40 from Group II) received oral probiotic Vagilac® for 10–14 days before delivery: 60 women to treat bacterial vaginosis, and 40 to prevent vaginal dysbiosis against the background of systemic antibiotic therapy. The remaining 40 pregnant women from Group II did not receive the probiotic, for which reason the second group was divided into two subgroups (IIa and IIb).Results: the drug has proved itself as a probiotic that is capable to restore vaginal microflora after various disorders, maintain and keep a healthy balance of bacteria that normally live in the vagina, prevent any disorders associated with antibiotic therapy. During vaginal delivery, traumatic injuries of the birth canal tissues were more common in patients who did not receive Vagilac®. The newborns who were born by the mothers who received Vagilac®, had no manifestations of severe forms of infectious and inflammatory diseases.The conclusion. The conducted studies showed that the treatment of bacterial vaginosis in pregnant women with probiotic Vagilak® was effective, did not adversely affect the fetus/child; in the group with and without BV no candidiasis vulvaginitis was detected.

Data on high prevalence of papilloma virus infection and associated disorders in adults as well as in adolescents are becoming more and more frequently published in the world and domestic literature. The most severe outcome of the infection is cervical cancer which takes the second place in women of reproductive age. At present, the armamentarium of obstetricians, gynecologists, pediatricians and oncologists is enriched by a recombinant vaccine protecting against human papilloma virus and representing one of effective methods of prevention of HPV-associated disorders. There are two prophylactic vaccines in the world (quadrivalent Gardasil® and bivalent Cervarix®), which are used in 44 countries. One of the first results proving efficacy of vaccination is a decrease of incidence of anogenital warts that is well described in foreign literature. In the Moscow region, as a result of vaccination performed from 2008 to 2013, a decrease of incidence of anogenital warts in girls is also observed.

Background: The course of pregnancy and delivery in patients with diffuse toxic goiter (DTG) is often complicated by preeclampsia, fetoplacental insufficiency, placental abruption and associated with higher maternal and perinatal mortality. Aim: To study particulars of fetoplacental complex functioning in DTG. Materials and methods: We assessed pregnant patients with DTG (n = 92) and their newborns (n = 94). By the time of delivery, 86 of patients were clinically and biochemically euthyroid. Functions of fetoplacental complex (by levels of placental lactogen, α-fetoprotein, estriol, progesterone and cortisol) were assessed by radioimmune and immunoenzyme assays. Fetometrical parameters of fetuses were studied by ultrasound method. Complex assessment of placentas was done by light and electronic microscopy. Results: Eighty seven (94,6%) patients with DTG had combined complications of pregnancy. The most frequent were: the threat of termination of pregnancy, in 68 (73.9%) of cases, low placenta placement, in 23 (25%), anemia, in 56 (60.9%), pre-eclampsia, in 56 (60.9%). In 59 of patients (64.1%), fetoplacental insufficiency was diagnosed, with predominance of strain or exhaustion reactions. Critical status of fetoplacental complex was found in pregnant patients with uncontrolled DTG and duration of control of less than 20 weeks, as well as in pregnant patients with DTG relapses. The values of main hormones (placental lactogen, α-fetoprotein and progesterone) were below 10th percentile.According to the results of the ultrasound assessments, fetuses from mothers with DTG during gestation demonstrated decrease of the majority or percentile parameters, such as biparietal cranial size, fetal femoral length, abdomen diameter, that was especially prominent in the groups with relapsing DTG.Eighty eight of 94 newborns (93.6%) were born full-term. In total, every third baby (29.3%) had some degree of intrauterine developmental delay at birth. Among the cases with controlled DTG in mothers, there were 21.2% of such babies, whereas among those with DTG relapses, 40%. There was an association between the length of DTG control during pregnancy and mass and body parameters of newborns: the shorter was duration of DTG control during gestation, the higher was the risk of low birth weight fetuses (р < 0.05).Histological assessment of placentas from DTG patients showed changes of endothelial microlandscape with sprouting of cell plasmolemma, blood cell adhesion and fibrin deposition. In 86% of placentas there were stasis, sludge formation and thrombosis in cord vessels.Conclusion: Pregnancy starting during uncontrolled DTG is typically associated with primary placental insufficiency that is morphologically characterized by profound metabolic abnormalities (stromal fibrosis, immaturity of the villous tree, blood flow abnormalities and ischemia). Morphological and functional placental abnormalities correlated with duration of uncontrolled DTG and lead to high rate of intrauterine developmental delay.

The article is a review of a study based on extensive clinical data (19 311 pregnant women) on pregnancy and indications for cesarean delivery. The frequency of operative delivery at extragenital diseases and complications of pregnancy is compared with perinatal mortality rate. Obstetric situations are demonstrated in which the caesarean section rate may be reduced without increasing perinatal mortality.

Необходимым условием для проведения операций трансвагинальным доступом является отсутствие воспалительного процесса половых органов. На современном этапе у здоровых женщин репродуктивного возраста микробиоценоз влагалища характеризуется преобладающей колонизацией кислотообразующих микроорганизмов и высокой частотой выявления облигатных анаэробов. Микробиологический профиль у больных с инфекционно-воспалительными заболеваниями отличается колонизацией биотопа влагалища различными представителями условно-патогенной группы с абсолютным доминированием облигатных неклостридиальных анаэробов и исчезновением или резким угнетением молочнокислых бактерий, бессимптомным вирусоносительством. Предоперационная подготовка и послеоперационное лечение этих больных представляют сложную задачу. При широком арсенале предложенных в последние годы консервативных методов лечения добиться полной санации и быстрой эпителизации раневой поверхности удается не всегда. Различные подходы к профилактике и лечению гнойно-воспалительных осложнений основаны, как правило, на выборе антибиотиков последних поколений. Наличие широкого спектра бактерий, вирусов и грибов в микробиоценозе влагалища затрудняет поиск надежного средства, которое действовало бы на все возможные виды микроорганизмов. Поэтому разработка эффективных мер по профилактике и лечению воспалительных процессов до и после оперативного лечения, особенно после трансвагинальных хирургических вмешательств, имеет особую значимость. Цель исследования Оценить эффективность, безопасность и переносимость препарата “Бетадин”, применяемого для профилактики и лечения воспалительных процессов и нарушений заживления в послеоперационном периоде при проведении оперативных вмешательств трансвагинальным доступом по поводу различной патологии гениталий. Проведенное исследование доказало, что бетадин является эффективным препаратом для наружного лечения инфекционно-воспалительных заболеваний гениталий, хорошо переносится больными. Побочные эффекты при его применении встречаются редко. Включение бетадина в комплекс лечебных мероприятий у пациенток с инфекционно-воспалительными заболеваниями гениталий будет способствовать более быстрой и эффективной эпителизации слизистой оболочки после оперативных вмешательств.