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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.

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 informative predictors of severe cerebral ischemia in preterm neonates.Materials and Methods. Study sample consisted of 80 preterm infants with intrauterine hypoxia or perinatal asphyxia delivered on the 28th-34th week of gestation. Levels of matrix metalloproteinase-9 (MMP-9) and thiobarbituric acid reactive substances (TBARS) as well as activity of antioxidant enzymes superoxide dismutase, catalase, and glutathione peroxidase in cord blood plasma of premature infants were evaluated immediately after birth.Results. As compared to other newborns, neonates with severe cerebral ischemia had higher levels of MMP-9 (MMP-9 > 305.6 ng/mL in 14.6% versus 69.7%, respectively) and TBARS in cord blood plasma.Conclusion. MMP-9 and TBARS measured in cord blood plasma of preterm infants may be utilised in diagnostics of severe cerebral ischemia.

Aim. To identify measures for the improvement of obstetric techniques and telemedicine technologies in women with major obstetric haemorrhage.Materials and Methods. We analyzed medical documentation of 54 women in Altai Krai who experienced major obstetric haemorrhage within 28- 36 weeks of gestation before (2008-2012) and after (2013-2017) implementation of risk management using the telemedicine “Registry of pregnancies” technology.Results. Implementation of risk management principles led to the admission of women with major obstetric haemorrhage exclusively to specialised hospitals in contrast to the preceding period. Further, it was associated with a higher prevalence of caesarean sections (from 55.6% to 96.3%) in women with major obstetric haemorrhage due to an increase in cases of complete placenta previa or placenta increta. In 73.0% of cases, such patients delivered in specialised hospitals where autologous blood transfusion or intrauterine balloon tamponade could be applied. In spite of increase in frequency of major obstetric haemorrhages, risk management reduced their severity by decreasing blood loss and, hence, the risk of posthaemorrhagic complications and blood transfusion side effects.Conclusions. Risk management-based strategy for optimising obstetric care by telemedicine technologies leads to the admission of high-risk, even “near miss” patients in specialised hospitals that is particularly efficient in regions with low population density and a large network of primary healthcare facilities.

The diagnostic and prognostic values of individual markers for intranatal fetal hypoxia were estimated to identify reserves for reducing hypoxic CNS lesions in full-term newborns. A set of (clinical, ultrasonic, laboratory) studies was conducted in 102 women who had delivered via cesarean section during term delivery for progressive fetal hypoxia. Doppler abnormalities in the mother - placenta -fetus system showed low sensitivity when predicting hypoxic CNS lesions. The most important diagnostic and prognostic markers of intranatal fetal hypoxia leading to cerebral ischemia were as follows: fetal growth retardation with grade IB placental circulatory disorders; abnormal intranatal cardiotocography with lactic acidosis in amniotic fluid, thick meconium amniotic fluid.

The study was carried out to establish admissible range of concentrations of lactate using standard biochemical method in amniotic fluid at first period of delivery under physiologically progressing pregnancy. The sampling included 44 women examined during first period of urgent delivery. The samples of amniotic fluid were taken during the first period of delivery using vaginal amnitomy. The concentration of lactate in samples of amniotic fluid was established using enzymatic amperometric technique. The reference values of concentration of lactate were established in the following admissible limits: 4.4-9.4 mmol per l; ratio lactate/creatinine - 17.7-79.4; ratio lactate/protein - 0.044-0.692. The admissible range of concentration of lactate and ratio lactate/creatinine and lactate/protein in amniotic fluid at first period of delivery under physiologically progressing pregnancy was established.

The aim of this study was to determine reference values of matrix metalloproteinases (MMPs) 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. Eighty nine 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 of MMP-1, MMP-2, MMP-9, and TIMP-1 have been investigated in amniotic fluid samples by ELISA kits. The following 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) have been determined for amniotic fluid samples obtained during 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, MMP-1/TIMP-1 ratio: 0.1–2.2, MMP-2/TIMP-1 ratio: 19.9–55.7; MMP-9/TIMP-1 ratio: 4.2–17.2.

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.Tsel'iu issledovaniia bylo ustanovit' dopustimye diapazony kontsentratsiĭ matriksnykh metalloproteinaz MMP-1, MMP-2, MMP-9 i tkanevogo ingibitora matriksnykh metalloproteinaz-1 (TIMP-1) v amnioticheskoĭ zhidkosti v pervom periode rodov pri fiziologicheski protekaiushcheĭ beremennosti. Obsledovano 89 zhenshchin v pervom periode srochnykh rodov. Obraztsy amnioticheskoĭ zhidkosti zabirali v pervom periode rodov vaginal'noĭ amniotomieĭ. Metodom immunofermentnogo analiza opredeleny kontsentratsii MMP-1, MMP-2, MMP-9 i TIMP-1 v obraztsakh amnioticheskoĭ zhidkosti. Ustanovleny dopustimye diapazony kontsentratsiĭ MMP-1, MMP-2, MMP-9, TIMP-1, a takzhe otnosheniia kontsentratsiĭ matriksnykh metalloproteinaz i ikh tkanevogo ingibitora (MMP-1/TIMP-1, MMP-2/TIMP-1, MMP-9/TIMP-1) v amnioticheskoĭ zhidkosti v pervom periode rodov pri fiziologicheski protekaiushcheĭ beremennosti. Oni sostavili: MMP-1 - 5,1-16,8 pg/mg belka, MMP-2 - 238,3-374,1 pg/mg belka, MMP-9 - 66,1-113,3 pg/mg belka, TIMP-1 - 4,7-13,6 pg/mg belka, otnoshenie MMP-1/TIMP-1 - 0,1-2,2, otnoshenie MMP-2/TIMP-1 - 19,9-55,7, otnoshenie MMP-9/TIMP-1 - 4,2-17,2.