Травма шейки матки — одна из главных причин развития рубцовых деформаций, стеноза и стриктуры шейки матки, а в ряде случаев и истмико-цервикальной недостаточности во время беременности. Целью исследования явилось рассмотрение последствий травмы шейки матки в качестве как медицинской, так и социальной проблемы. Цель была достигнута путем использования аналитического метода: проведен детальный систематический анализ современной отечественной и зарубежной литературы. В исследовании использовались такие информационные базы, как: e-library, Scopus, PubMed, MEDLINE, ScienceDirect, Cochrane Library с момента создания до декабря 2021 г. Последствия травмы шейки матки, несмотря на наличие четких представлений о факторах риска и методах диагностики, остаются важной медицинской и социальной проблемой, требующей дальнейшей разработки методов прогнозирования, профилактики и высокоэффективного лечения.

В статье представлено очень редкое клиническое наблюдение ранней неонатальной гибели новорожденного с врожденными острым миелобластным лейкозом и генерализованной герпес-вирусной инфекцией. При плановом ультразвуковом исследовании в 32 нед были выявлены признаки кардиомегалии и гидроперикарда у плода. По данным ультразвуковой допплерографии, зафиксировано нарушение маточно-плацентарного кровотока II степени. Пациентка была госпитализирована в стационар третьего уровня, где было диагностировано ухудшение состояния плода по данным кардиотокограммы. Пациентка была родоразрешена путем кесарева сечения, родился живой недоношенный мальчик в состоянии тяжелой асфиксии. Состояние ребенка с рождения расценивалось как крайней степени тяжести, что было обусловлено стойкой артериальной гипотензией, угнетением ЦНС и морфофункциональной незрелостью. Обращал внимание выраженный отечный синдром: распространенные отеки, асцит, гидроторакс и анурия с рождения. В клиническом анализе крови наблюдались гиперлейкоцитоз, наличие бластных клеток, тромбоцитопения. По данным иммунофенотипирования выявлен острый миелоидный лейкоз. Несмотря на весь комплекс проводимой терапии, на 5-е сутки констатирована смерть новорожденного. При патологоанатомическом исследовании диагноз врожденного острого миелобластного лейкоза подтвержден. Дополнительно выявлена врожденная генерализованная герпес-вирусная инфекция, двусторонняя интерстициальная пневмония, интерстициальный гепатит, диффузный продуктивный менингит, очаговый интерстициальный миокардит. Представленный случай демонстрирует возможность одновременного развития у плода двух крайне редких, таких взаимно утяжеляющих заболеваний, как острый миелобластный лейкоз и генерализованная герпес-вирусная инфекция.

Abstract. In the Russian Federation, approximately 5 % of births are complicated by postpartum haemorrhage. Postpartum haemorrhage is the leading cause of maternal morbidity and mortality worldwide. Most maternal deaths associated with bleeding can be prevented. Identifi cation of risk factors, methods of prediction and timely recognition of postpartum haemorrhage remain serious problems in obstetrics. The aim of the research was to analyse modern methods for prediction and diagnosis of postpartum haemorrhage. Material and methods. Th e aim of the research was achieved through the analytical method: a detailed systematic analysis of modern Russian and foreign literature on methods for predicting and diagnosing postpartum hemorrhage was carried out. The study used such databases as e-library, Scopus, PubMed, MEDLINE, ScienceDirect, Cochrane Library and FIIP for search of publications dated January 2015 to December 2021. Results. Postpartum haemorrhage, despite the widespread implementation of clinical guidelines in obstetric practice, remains a serious medical problem. Modern prediction methods are based on risk stratification and do not provide for accurate prediction of development of such a formidable complication. Today, a method for automatic monitoring of postpartum uterus volume for early diagnosis of postpartum haemorrhage has been developed. However, such a technology has only been implemented in a number of scientific studies. Conclusion. Methods for diagnosing postpartum haemorrhage are diverse and each of them has its own advantages and disadvantages, i.e. they can only be effective when used in combination. Also, an important role in prediction and timely diagnosis of postpartum haemorrhage is played by the level of training of medical personnel and their teamwork skill.

ОЦЕНКА РЕЗУЛЬТАТИВНОСТИ ПРИМЕНЕНИЯ КОНТАКТНЫХ И ДИСТАНЦИОННЫХ ОБРАЗОВАТЕЛЬНЫХ ТЕХНОЛОГИЙ В РАМКАХ ОБУЧЕНИЯ ДИСЦИПЛИНЕ «АКУШЕРСТВО И ГИНЕКОЛОГИЯ»Мочалова М.Н

An experimental model of an original device for the diagnosis of uterine scar integrity in the early postpartum period is described. The design of the device is described, along with methods of assessing uterine scar integrity in the early postpartum period; the effectiveness of using this device for the diagnosis of defects is assessed in an experimental model. The diagnostic accuracy of the device is compared with that of manual examination of the uterine cavity.

Rational management of labor refers to the most significant areas of practical obstetrics, since errors in predicting the outcome of labor through the birth canal often lead to the development of birth injury to the mother and fetus. Modern research methods and rational management of childbirth have led to a decrease in perinatal mortality. However, despite these achievements, the incidence of birth injury and subsequent disability of newborns is still at a level that is not acceptable for the XXI century.The purpose of the research was to study the structure and outcome of the generic injury of the fetus.Materials: Literature of foreign and domestic authors within the period from 2003 to 2018.Methods: Systematic analysis and synthesis of literary data.Conclusion: Despite the decline in perinatal mortality, the problem of disability of children, as well as violations of the quality of life due to birth trauma, remains relevant. This requires further study, the introduction of new diagnostic and clinical and prognostic technologies aimed at reducing birth injuries. Prevention of birth injury should be based on timely prenatal diagnosis of fetal macrosomia, determination of the optimal method of delivery, exclusion of iatrogenic factors of aggression during birth through the birth canal.

The aim of the study was to compare the effectiveness of traditional and distance educational technologies. Materials and methods. The effectiveness of the studied technologies was evaluated based on the analysis of the results of the final state certification. Results. The use of traditional and distance educational technologies in teaching students by obstetrics and gynecology is comparable. Conclusions. In the future, we should consider the possibility of transferring some sections of the educational process in medical educational institutions to a distance format.

ОЛИМПИАДНОЕ ДВИЖЕНИЕ КАК МЕТОД ПРОФИЛАКТИКИ ПРОФЕССИОНАЛЬНОЙ НЕКОМПЕТЕНТНОСТИ БУДУЩИХ ВРАЧЕЙ АКУШЕРОВ-ГИНЕКОЛОГОВМочалова М.Н., Мудров В

Currently, there are many points of view on management of physiological labor, in particular, it concerns the intrapartum position of a woman. Tactics of modern obstetrics should ensure the safety of motherhood, which in future ensures the prosperity of the state. One of the alternative methods of delivery is the vertical position of a woman in the intrapartum period. It is impossible to describe the whole range of possible positions of a woman in the intrapartum period, the common ones being: lying position (lateral, reclining, lithotomy, Trendelenburg’s, etc.) or upright position (sitting, using a chair for childbirth, standing, squatting, standing on the knees, etc.). Opinions about how the vertical position of a mother in the intrapartum period affects the outcome of childbirth are quite ambiguous. The conclusions of various authors on that matter often contradict each other.The aim of the research was to study the role of vertical delivery in reducing the frequency of obstetric and perinatal complications.Materials: publications of foreign and domestic authors within the period from 1989 to 2017.Methods: systematic analysis and synthesis of literature data.Conclusion: Despite a significant number of studies, it is not possible to determine the universality of the vertical position in childbirth, therefore, the selection of patients for the management of vertical childbirth should be approached carefully. In the presence of pregnancy complications, preference should be given to the classic version of the position in childbirth. In women who have a low risk of perinatal complications, an upright position can be a worthy alternative. To prevent the development of bleeding in the III stage of labor and the early postpartum period, a woman should take a horizontal position after the birth of the fetus. This condition must also be observed when examining the birth canal. Thus, the rational tactics of conducting childbirth is to determine the optimal combination of vertical and horizontal positions at different periods of the childbirth process, taking into account the convenience for the woman in labor.

Trombotic microangiopathy is heterogeneous group of the diseases united by a community of a histological and clinical implications at difference of pathogenetic mechanisms, presents clinical-morphological syndrome characterizing a lesion of vessels of a microcirculatory channel. Currently thrombotic microangiopathy include thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremic syndrome (aHUS), heparin-induced thrombocytopenia, HELLP-syndrome. One of the most important triggers of emergence of a thrombotic microangiopathy is pregnancy. The article describes the clinical observation of atypical hemolytic uremic syndrome in obstetric practice.

The results of anonymous interrogation of the female students of the Chita state medical academy are presented. Fixed, that there is an expressed social determination of sexual and reproductive conduct of the medical female students, which features is the rather late sexual debut, prevailing of the monogamous relations, low frequency of regular use of modern reliable contraceptive methods, planned one ore two children family.

The finding suggest that national culture and religion influence to forming of sexual behavior and reproductive directions of teenagers girls living in Aginsk Autonomic District and Chita Region

The article is devoted to the study of possible HPVrole in cytokine regulation ofapoptosis and proliferation of cells under cervical intraepithelial neoplasia (CIN). The data of the investigation of cervical mucus and bioptates of cervix uterine in 150 patients with CIN are given. HPV was detected with PCR, TNF-a and TGF-s content with ELISA apoptosis and proliferative activity with immunohistochemical method with monoclonal antibodies p53, bcl-2, PCNA. Development of CIN in combination with HPV was held with increased expression of TGF-s with unchanged TNF-a and high level of PCNA expression and bcl-2 which was indicated only in presence of HPV. High level of TNF-awas associated with increased p53 expression under chlamydial, bacterial, cytomegalovirus infections. However, PCNA expression was rather high in HPV in comparison with other infections. HPV with CIN characterized the changed regulation of cytokines with high proliferative activity and diminished apoptosis.