Abstract. Aortic dissection is a rupture of the inner layer of the aorta with subsequent penetration of blood into the degeneratively altered middle layer with the formation of false lumen and true lumen. Pregnancy is one of the risk factors for the development of aortic dissection. The incidence of aortic dissection during pregnancy is only 0.0004% of cases.Aim of the study. To analyze national and foreign literature, as well as share own clinical observations in the diagnosis and treatment of patients with aortic dissection in the postpartum period.Material and methods. Two patients after successful childbirth, in the late postpartum period, were admitted with a diagnosis of aortic dissection type A according to Stanford.CT angiography confirmed the presence of Stanford type A aortic dissection. After additional examination, surgical treatment was performed to replace the aortic valve and ascending aorta under artificial circulation, with a satisfactory clinical result.Conclusion. The diagnosis of aortic dissection should be considered in all pregnant women with chest pain, as this condition often goes undiagnosed.The pregnancy period is one of the risk factors for the development of aortic dissection with a high mortality rate. The likelihood of developing aortic dissection in women at risk peaks in the third trimester and the first 12 weeks after delivery.The risk group should include women with confirmed syndromic and non-syndromic genetic diseases, bicuspid aortic valve, coarctation of the aorta, or at least one major criterion indicating the presence of aortopathy (ectopia lentis, aortic aneurysm, habitus, genetic testing).If Marfan syndrome is present, surgical intervention should be considered if the maximum aortic diameter is more than 4.5 cm before pregnancy. In women with Marfan syndrome and aortic dissection in the family history, as well as in the presence of more aggressive genetic diseases (Loeys-Dietz syndrome, Ehlers-Danlos syndrome), it is possible to consider preventive surgical treatment for an aortic diameter of 4.0 cm or more.The delivery in high-risk patients is recommended to be performed in a hospital that has a cardiac surgery service and an “aortic” team.

The study objective Is to present a clinical observation, describe the diagnostics and treatment of acute transmural myocardial infarction in a patient on the 8th day after childbirth Material and methods A 31-year-old patient was hospitalized 3 hours after the onset of the disease on the 8th day after urgent spontaneous delivery at 38-39 weeks of gestation with a clinic of acute myocardial infarction in the intensive care unit. Based on the data of anamnesis, complaints, physical examination, results of instrumental and laboratory examination, the following clinical diagnosis was made: ischemic heart disease: acute transmural myocardial infarction of the anterior wall, septum and apex of the left ventricle; atherosclerosis of the aorta and coronary arteries. On an emergency basis, the patient underwent coronary angiography, pronounced atherosclerotic changes in the coronary arteries were revealed: acute occlusion of the anterior interventricular artery in the middle third, stenosis of the diagonal branch up to 70% in the orifice, stenosis of the circumflex branch up to 70% in the middle third, extended stenosis up to 79% in the middle third of the right coronary artery. Results The patient underwent percutaneous coronary intervention (pci) on a symptom-dependent artery: mechanical recanalization and stenting of the anterior descending artery (ada) by a drug-eluting stent. Conclusion An increase in the incidence of acute coronary syndrome in pregnant women and postpartum women requires the development of an algorithm for additional examination of late reproductive age patients at the stage of pregnancy planning, in case of identification of possible risk factors for the development of cardiovascular diseases — observation of a cardiologist during pregnancy and in the postpartum period.

We retrospectively studied the age, sex structure and medical conditions of urgent pathology among HIV-infected persons at Sklifosovsky Research Institute for Emergency Medicine. For the period from 2008 to 2015, the number of patient’s hospitalizations with HIV to the emergency hospital increased in 1,5 times as among men (R2 =0,63, p=0,0188), and women (R2 = 0,84, p=0,0013). The greatest number of admissions HIV-infected persons registered at the emergency departments (R2 =0,57, p=0,03). The main share of people with HIV infection were citizens in the age groups 18-30 and 31-40 years old. At the same time, we were revealed multidirectional trends connected with decreasing number of hospitalized patients in the age group of 18-30 years (R2 = 0,51, p = 0,04) and increasing in groups of 31-40 (R2 = 0,71, p = 0,008) and 41-50 years (R2 = 0,89, p = 0,0004). The share of HIV-infected men decreased from 68,1 to 65,1% while women have increased from 31,9 to 34,9%. The differentiation of the epidemic process for HIV-infection among patients in different clinical departments noticed.

РОССИЙСКИЙ ВЕСТНИК АКУШЕРА-ГИНЕКОЛОГА 3, 2018 © О.Б. Шахова, С.А. Солонин, 2018 Оказание экстренной акушерско-гинекологической помощи пациенткам, инфицированным вирусом иммунодефицита человека (ВИЧ), является чрезвычайно важной и актуальной проблемой. По оценке экспертов ООН, в 2015 г. в мире насчитывались 36,7 млн человек, живущих с ВИЧ, из которых 17,8 млн (48,5%) — женщины [1, 2]. Динамика распространения ВИЧ-инфекции в различных странах имеет свои особенности [1, 3]. По данным ЮНЭЙДС (UNAIDS — Joint United Nations Programme on HIV/AIDS), в Российской Федерации отмечены высокие темпы роста числа инфицированных по сравнению с другими странами. В 2015 г. из числа стран Восточной Евро-

The study of microcirculation is one of the most growing diagnostic areas. The article summarizes the literature on microcirculation disorders in gynecological patients. Modern methods of microcirculation disorders diagnostics have been analyzed. We also described techniques of laser Doppler fl owmetry (LDF) to assess changes in local microcirculation of the pelvic organs. The results of the clinical use of this technique in patients with various gynecological diseases are reported.

The study of microcirculation is one of the most growing diagnostic areas. The article summarizes the literature on microcirculation disorders in gynecological patients. Modern methods of microcirculation disorders diagnostics have been analyzed. We also described techniques of laser Doppler fl owmetry (LDF) to assess changes in local microcirculation of the pelvic organs. The results of the clinical use of this technique in patients with various gynecological diseases are reported.

The time course of changes in the serum levels of average mass molecules and malondialdehyde in patients with pelvic peritonitis was studied within two weeks after surgery. The values of the above indices of endogenous intoxication (EI) were found to be 1.3-2.9 times higher than the normal values almost throughout the follow-up (p < 0.05). An integral EI coefficient (EIC) including relative (as compared with the normal values) EI indices was proposed to evaluate the magnitude of EI. In patients with pelvic peritonitis, EIC was established to be 2.9-4.8 times greater than the normal values (p < 0.05) in all follow-up periods. Thus, the application of EIC enhances the sensitivity of EI diagnosis in patients with pelvic peritonitis as compared with that in the determination of individual EI indices.

The parameters of endogenous intoxication (EI) were studied in patients with inflammatory small pelvic organs diseases complicated by organs pelviperitonitis and generalized peritonitis. The integral index of EI--endogenous intoxication coefficient (EIC) was developed, which included relative values (as to the normal values) of the total and effective concentration of albumin, medium molecular peptides and leukocytic intoxication index. The values multiplied together are EIC. In patients with inflammatory small pelvic organs diseases, the level of EI was shown to considerably increase. The use of EIC was ascertained to significantly increase the accuracy of diagnosis of early-stage EI, to perform detoxifying therapy, and monitor its efficiency, as confirmed by the use of sodium hypochlorite in the combined treatment of patients with inflammatory small pelvic organs diseases.