Введение. В клинических рекомендациях подробно описаны алгоритмы антикоагулянтной терапии (АКТ) у беременных с механическими протезами клапанов (МПК) сердца в дородовом периоде. Однако подходы к восстановлению приема варфарина после родов освещены недостаточно полно. Цель исследования: определить наиболее безопасную тактику возобновления АКТ в послеродовом периоде у пациенток с МПК сердца. Материалы и методы. Проведено ретроспективное описательное исследование течения послеродового периода у 49 женщин с МПК сердца. Насыщение варфарином проводилось на фоне инфузии нефракционированного гепарина (группа НФГ; n = 30), либо низкомолекулярного гепарина в лечебной дозе (группа НМГ; n = 19). Определяли частоту тромбоэмболических и гемор­рагических осложнений, повторных оперативных вмешательств, трансфузий компонентов крови. Результаты. Тромбозы и дисфункции протезов не выявлены в обеих группах. Геморрагические осложнения в группе НФГ составили 16,7%, в группе НМГ — 52,6% (p = 0,01). Операции по поводу кровотечений были выполнены 6,7% пациенткам в группе НФГ и 36,8% пациенткам в группе НМГ (p = 0,012). Гемотрансфузии потребовались 6,7% пациенток в группе НФГ и 36,8% пациенток в группе НМГ (p = 0,012); трансфузии свежезамороженной плазмы в группе НФГ не проводились, но потребовались 21,1% женщин в группе НМГ (p = 0,018). Найденные закономерности получили статистическое подтверждение для подгруппы пациенток, у которых НМГ дозировали по анти-Ха активности (n = 11), и не были подтверждены для подгруппы пациенток, которым НМГ назначали с расчетом дозы по массе тела (n = 8). Заключение. Восстановление приема варфарина после родоразрешения сопровождается высоким риском кровотечений при использовании НМГ, дозированного по анти-Ха активности, в сравнении с НФГ. Introduction. The clinical guidelines detail the algorithms for anticoagulant therapy (ACT) in pregnant women with mechanical heart valves (MHV) in antenatal period. However, approaches to warfarin re-administration after delivery are scarce. Aim: to identify the safest ACT rechallenge strategy in the postpartum period in patients with MHV. Materials and Мethods. A retrospective descriptive study of postpartum period included 49 women with MHV. Saturation with warfarin was associated with unfractionated heparin infusion (UFH group; n = 30) or low molecular weight heparin at a therapeutic dose (LMWH group; n = 19). We determined the frequency of thromboembolic and hemorrhagic complications, repeated surgical interventions, and blood component transfusions. Results. No thromboses or prosthetic dysfunction were reported in both groups. Hemorrhagic complications in the UFH group accounted for 16.7%, in the LMWH group — 52.6% (p = 0.01). Surgical treatment of bleeding was performed in 6.7% of patients in the UFH group and in 36.8% of patients in the LMWH group (p = 0.012). Blood transfusions were required for 6.7% of patients in the UFH group and 36.8% of patients in the LMWH group (p = 0.012); fresh frozen plasma trans­fusions were not performed in the UFH group but were required for 21.1% of women in the LMWH group (p = 0.018). The patterns found were statistically confirmed for the subgroup of patients in whom LMWH was dosed according to anti-Xa activity (n = 11), and were not confirmed for the subgroup of patients who received LMWH based on body weight (n = 8). Conclusion. Warfarin rechallenge after delivery is associated with a high risk of bleeding when using LMWH dosed according to anti-Xa activity as compared with UFH.

Тромбоз артерии пуповины (ТАП) является редким, труднодиагностируемым пренатально осложнением беременности, в связи с чем не существует общепринятых принципов профилактики и ведения таких пациенток, не разработаны клинические рекомендации. Представляем клинический случай течения беременности у пациентки с отягощенным соматическим анамнезом, завершившейся развитием острого ТАП. Антенатальное применение медикаментозной профилактики венозных и артериальных тромбоэмболических осложнений, очевидно, отсрочило развитие острого ТАП до доношенного срока – момента наивысшего риска реализации всех тромбоэмболических осложнений во время беременности. Острая гипоксия плодаявилась показанием к экстренному оперативному родоразрешению и, несмотря на быстро принятые меры, реализовалась в тяжелую асфиксию при рождении. Приводится анализ возможных причин развития ТАП, обсуждаются современные международные подходы к медикаментозной профилактике сердечно-сосудистых осложнений во время беременности. Необходимо привлечение внимания к значимости соматических заболеваний в формировании перинатальных рисков, а также важности индивидуального подбора медикаментозной профилактики возможных неблагоприятных последствий для матери и плода. Umbilical artery thrombosis (UAT) is a rare and difficult to diagnose prenatal complication of pregnancy, that’s why there are neither generally accepted principles nor clinical practice guidelines for the prevention and management of this condition. In this article we present a clinical case of pregnancy with somatic concomitant diseases that culminated in the development of acute UAT. Antenatal medical preventive measures of venous and arterial thromboembolic events must have been delayed the development of acute UAT till the full term – the peak time for all the thromboembolic events during pregnancy. Fetal distress was an indication for emergency operative delivery and, despite the quickly taken measures, was realized in severe asphyxia at birth. An analysis of the possible causes of UAT development is given, and modern approaches to pharmacological prophylaxis of cardiovascular complications during pregnancy are discussed. It is necessary to draw attention to somatic diseases in theformation of perinatal risks, as well as the importance of individual selection of pharmacological prophylaxis of possible adverse consequences for the mother and fetus.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года РАНДОМИЗИРОВАННОЕ КОНТРОЛИРУЕМОЕ ИССЛЕДОВАНИЕ ПРИМЕНЕНИЯ РАЗНЫХ ЦЕЛЕВЫХ УРОВНЕЙ ГЛИКЕМИИ У

Background. Data on the effect of the number of received oocytes on the outcomes of assisted reproductive technology (ART) programs are contradictory. The frequency of obtaining a small number of cells ranges from 5.6 to 35.1 %. Identifying women who have chances of getting pregnant, despite this situation, is important for drawing up an adequate treatment plan. Objective of this study is to assess the pregnancy rate depending on the number of retrieved oocytes in ART cycles with ovarian stimulation, which ended with the transfer of embryos, as well as determining the characteristics of patients with a reduced response, in whom the pregnancy occurred. Design and methods. The study included 526 women who were treated for infertility in the department of ART of the Almazov National Medical Research Centre in 2017. Patients were divided into three groups depending on the number of oocytes retrieved: less than 5, from 5 to 9 and 10 or more. Group 1 (number of oocytes less than 5) included 126 women, group 2 (from 5 to 9) — 223 women and group 3 (number of oocytes 10 and more) — 177 patients. The average age of the patients was 33.37 years (from 22 to 48 years). Results. The frequency of obtaining a positive blood test and clinical pregnancy rate were comparable in groups 2 and 3 (53.81 % and 49.72 %, respectively) and significantly lower in group 1 (41.27 %, p > 0.05). Clinical pregnancy in group 1 occurred in 34.13 % of cases, which was significantly different from the indicators of group 2 + 3, where the gestational egg visualized in 47.5 % of cases (p < 0.05). In a group of women with a small number of oocytes, the most important predictors of pregnancy were obtaining 2 or more oocytes, and anti-mullerian hormone (AMH) level above 1 ng / L. Conclusion. The number of oocytes is an important predictor of pregnancy rate. The chances of becoming pregnant in women with a small number of oocytes depend on the level of AMH and the number of oocytes obtained.

Objective. To estimate the rate of bone metabolism depending on the saturation of vitamin D during pregnancy. Materials and methods. Cohort retrospective and prospective study. There were examined 110 pregnant women in Saint Petersburg and Leningrad region. Mean age 29,64±2,3 years, 30-38 weeks of gestation. Time of inclusion is from September till June. All pregnant women had blood sampling with the following estimation of the level of 25-hydroxycalciferol, parathyroid hormone, osteocalcin and s-isomer of C-terminal telopeptide of type I collagen. From 12 gestational weeks all patients received multivitamin complex, containing 400 IU of vitamin D. Results. There have been analyzed three subgroups of pregnant women. Insufficiency and deficiency are found in 55,5% of pregnant women. Blood serum level of parathyroid hormone was 23,47±5,90 pg/ml in pregnant with normal saturation of vitamin D, with vitamin D insufficiency- 31,36±9,44 pg/ml, with vitamin D deficiency 46,96±18,44 pg/ml (p<0,05). Mean levels of biochemical markers of bone tissue remodeling were the following: in pregnant women with normal saturation of vitamin D - osteocalcin was 14,68±3,54 ng/ ml, s-CTX was 0,637±0,210 ng/ml, with vitamin D insufficiency - osteocalcin was 24,5±8,29 ng/ml, s-CTX was 0,705±0,170 ng/ml, with vitamin D deficiency - osteocalcin was 34,01±7,25 ng/ml, s-CTX was 0,831±0,140 ng/ml (p<0,05). Conclusions. Insufficient saturation of pregnant women with vitamin D is associated with the changes of the rate and way of bone metabolism. It increases both osteosynthesis and osteoresorption: level of osteocalcin increases 2 times in blood serum, level of s-CTX increases 1,3 times. Pregnant women with the insufficient saturation of vitamin D show the increase of parathyroid hormone. That means the possibility to save bone metabolism with the function of osteosynthesis and osteoresorption. Pregnant women with the revealed insufficiency and deficiency of vitamin D refer to the group of risk for the development of osteopenia and postpartum ruptures.

This article highlights the main activities of the Department of Obstetrics and Gynecology of Federal Almazov North-West Medical Research Centre. Special attention is given to postgraduate education on the basis of a simulation training center, the primary specialization of doctors in obstetrics and gynecology. Also copyrights cycles held at the chair are discussed in details.

Objective. of this study is to review the main aspects of classifi cation, clinical picture, diagnostic methods, possible complications and the treatment options of hypertension during pregnancy on an example of clinical case. Case report. In present study there was a resistant hypertension not amenable to medical treatment in a young patient. Conclusion. Feature of this clinical case is the description of the diffi culties of antihypertensive therapy selection during pregnancy.

This review summarizes current understanding of the function of blood vessels, valuation methodologies the vascular wall, the adaptive changes that occur in it during normal pregnancy.

This review focuses on new principles of management of patients with endometriosis according to a global consensus of 2013. The role of combined oral contraceptives in the prevention and treatment of endometriosis is discussed.

During pregnancy the levels of IGF-I increase and in III trimester exceed greatly the values of I trimester. Its significant increase is noted from 22-24 weeks of pregnancy. Correlation analysis revealed a moderate negative correlation between the level of IGF-I in II trimester and distal forearm BMD (r = -0,35, p

The current trends in the diagnostics and treatment of postmenopausal osteoporosis are considered. A review of the results of clinical studies of strontium ranelate in patients with this condition is presented. It is concluded that this agent may be an efficacious tool for the treatment of postmenopausal osteoporosis.