The present study is due to the high urgency of the problem of managing preterm labor initiated by premature rupture of the membranes. The purpose of this study was to analyze obstetric and neonatal outcomes during the prolongation of preterm pregnancy complicated by premature rupture of the membranes, and to assess the health status of newborns. Clinical observations were carried out on the basis of the State Health Institution "Clinical Perinatal Center of the Saratov Region".In 148 patients with a singleton pregnancy (the main observation group) at a period of 28-34 weeks, prenatal rupture of water occurred, while the pregnancy was prolonged to achieve greater morphological and functional maturity of the fetus. In 181 patients with a singleton pregnancy at the same gestational age, preterm labor occurred within the next 6-12 hours after prenatal rupture of water; these patients were included in the comparison group. Pregnancy in patients of the main group was prolonged by an average of 12.2±1.9 days (from 2 to 29 days). The paper presents the structure of indications for terminating the prolongation of preterm pregnancy with prenatal rupture of water, an analysis of the characteristics of the course of the birth act and the structure of indications for delivery by caesarean section in patients with premature pregnancy after a period of prolongation of gestation. A comparative analysis of the condition of 148 children born to patients of the main group and 181 newborns born to women of the comparison group showed the advantages of expectant management of patients with premature rupture of the membranes during preterm gestation. A decrease in the frequency of development and severity of respiratory disorders, the frequency of occurrence and degree of intraventricular hemorrhages in premature babies with the prolongation of a premature pregnancy complicated by prenatal rupture of water has been proven.

The frequency of detection of human papilloma virus (HPV) DNA in pregnant women varies in different populations. HPV is a significant factor of spontaneous abortions, preterm labor, pre-eclampsia, low-weight to the period of gestation of the fetus. With HPV, vertical or hematogenous infection of the fetus can occur. The risk of contamination is reduced due to delivery by cesarean section and in case if C-reactive protein levels over 10 mg/dL.

The decline in the quality of life due to various menopausal disorders in the early postmenopausal period is actually the main reason that leads a woman to seek medical help. Despite this, not enough attention is paid to this problem. Currently, the concept of the formation of individual menopausal symptoms into clusters is emerging to optimize treatment and diagnostic algorithms for managing this category of patients. The aim was a comparative analysis of the menopausal disorders most associated with a decrease in the quality of life. Included were 230 women with climacteric disorders (95 with bilateral oophorectomy; 135 with natural menopause). The assessment of the severity of climacteric disorders was carried out according to the Kuperman index modified by E.V. Uvarova. The SF-36 Health Status Survey was used to assess the quality of life. The average age of patients with surgical menopause was 47.9±2.2 years, with natural menopause - 53.6±3.5 years (p˂0.05). The duration of the estrogen deficiency state in the groups was comparable - 2.8 ± 0.6 years (p>0.05). All patients had a moderate degree of menopausal syndrome (p>0.05), however, the values of the modified menopausal index differed significantly: with postovarectomy syndrome - 57.8±1.1 points, with menopausal syndrome - 49.7±0.9 points (р <0.05). In both groups, a decrease in the quality of life was observed: the total physical component (with postovarectomy syndrome up to 57.2 (36.6; 72.7), with menopause - up to 68.4 (49.3; 83.5)) and the total psychological component (up to 53.9 (42.9; 76.7) and 64.1 (47.3; 84.5), respectively). In contrast to our approach, the formation of clusters of menopausal symptoms, based on the generally accepted approach to the analysis of climacteric disorders (psychological, vasomotor, somatic), provided a significantly smaller sample coverage (with surgical menopause - 68.5%, with natural - 62.6% variance) With a duration of estrogen deficiency of 2.8 ± 0.6 years, the cluster of menopausal disorders, which has the maximum negative effect on the quality of life, includes symptoms: hot flashes, cognitive disorders, sleep disturbances, anxiety, and covers 80.3% of the variance in postovarectomy syndrome, in menopausal - 73.6%. Knowledge of this fact contributes to the identification of risk groups and allows formulating new algorithms for the management of postmenopausal women.

В работе проведено изучение состояния процессов перекисного окисления липидов в крови больных с острым сальпингооофоритом, а также обоснование использования антиоксидантной терапии в комплексном лечении пациенток с указанной патологией. В группе из 50 пациенток с острым сальпингооофоритом проведено традиционное лечение, включающее антибактериальные средства в соответствии с клиническим протоколом диагностики и лечения воспалительных заболеваний органов малого таза (2015), противовоспалительную, дезинтоксикационную терапию (группа сравнения). У 50 пациенток с острым сальпингооофоритом аналогичная комплексная терапия была дополнена назначением препаратов со свойствами антиоксидантов (основная группа). При поступлении больных в стационар и после проведения терапии выполнена оценка состояния процессов перекисного окисления липидов в крови по содержанию продуктов липопероксидации в плазме крови и в эритроцитах, а также состоянию антиоксидантной системы крови. Результаты проведенных исследований свидетельствуют об активации перекисного окисления липидов и дестабилизации биологических мембран у больных с острым сальпингооофоритом. Показано, что использование антиоксидантной терапии в комплексном лечении больных с острым сальпингооофоритом способствует сокращению сроков лечения в стационаре и улучшает отдаленные результаты лечения пациенток с указанной патологией. The study of the state of lipid peroxidation processes in patients with acute salpingo-oophoritis, as well as the rationale for the use of antioxidant therapy in the complex treatment of patients with this pathology, was carried out. In a group of 50 patients with acute salpingo-oophoritis, traditional treatment was performed, including antibacterial agents in accordance with the clinical protocol for the diagnosis and treatment of pelvic inflammatory diseases (2015), anti-inflammatory, detoxification therapy (comparison group). In 50 patients with acute salpingo-oophoritis, similar complex therapy was supplemented by the appointment of drugs with antioxidant properties (main group). When patients were admitted to the hospital and after therapy, the state of lipid peroxidation processes in the blood was assessed by the content of lipid hydroperoxides and malondialdehyde in blood plasma and in red blood cells, as well as the state of the antioxidant blood system. The results of the studies indicate the activation of lipid peroxidation and the destabilization of biological membranes in patients with acute salpingo-oophoritis. It is shown that the use of antioxidant therapy in the complex treatment of patients with acute salpingo-oophoritis helps to reduce the treatment time in the hospital and improves the long-term results of treatment for patients with this pathology.

The aim of this work is to study the state of the problem of the development of small-for-gestational-age fetus and fetal growth restriction over the past 5 years. A review of randomized trials of the PubMed database for the period of 2015 to 2020 was carried out. Experts reached an agreement on the definition of diagnostic criteria for small-for-gestational-age fetus and fetal growth restriction, a clinically valid classification was created, and the main monitoring strategies were developed. Due to the different pathogenesis, fetal growth restriction is divided into early and late. The observation algorithm includes tests that have shown higher sensitivity and specificity. There is no single standard for the median weight and abdominal circumference of a fetus, indicators of the reference range for fetal Doppler. Smoking cessation and taking acetylsalicylic acid at a dose of 150 mg at high risk of preeclampsia is recommended to prevent the small-for-gestational-age fetus and fetal growth restriction. The pregnancy management algorithm includes Doppler ultrasound examination of the umbilical artery, cardiotocography. If this pathology occurs before 32 weeks of pregnancy, the blood flow in ductus venosus is additionally examined, and after 32 weeks of pregnancy, the middle cerebral artery blood velocities and cerebroplacental ratio are assessed. Indicators of Doppler velocimetry and cardiotocography, which serve as criteria for early termination of pregnancy, are developed, measures are proposed to improve neonatal outcomes prevention of respiratory distress syndrome at 2434 weeks of gestation, as well as magnesium therapy for fetal neuroprotection. The problems of preventing fetal growth restriction and the algorithm for monitoring pregnant women who do not have risk factors for small-for-gestational-age fetus, management tactics and indications for delivery while slowing fetal weight gain remain unresolved.

Hot flashes are known to be associated with a variety of cardiovascular risk factors. There is evidence of a close relationship between hot flashes and autonomic dysfunction, while the parameter - heart rate variability (HRV) - is a surrogate marker for assessing the activity of the autonomic nervous system (ANS). However, changes in HRV can be caused by both aging and hormonal changes. The purpose of this work is to consider the role of endogenous estrogens in the autonomic regulation of the cardiovascular system on the model of "acute estrogen deficiency" in cases of total oophorectomy and "partial estrogen deficiency" - in cases of hysterectomy with / without appendages. 44 women were included, mean age - 46.9 ± 2.2 years, whose HRV was assessed before surgery (1 week before surgery) and after (not less than 4 and not more than 5 weeks after surgery). According to the results obtained, there were no statistically significant changes in both temporal and spectral HRV parameters in patients after hysterectomy (p> 0.05). On the contrary, patients with total oophorectomy in the postoperative period showed decreased HRV parameters characterizing the parasympathetic activity of the ANS, namely SDRR, rMSSD, pNN50, HF and the LF index, reflecting both sympathetic and parasympathetic effects on heart rate. Patients with total oophorectomy have a higher ratio of the sympatovagal LF / HF index; the work shows that this fact is most likely due to the predominance of sympathetic nervous influences induced by "acute" withdrawal of ovarian hormones due to the performed volume of surgery, and not as a result of surgery. as such, or its psychological consequences. Thus, according to the above-described results of the study, patients in cases of total oophorectomy showed a decrease in the parameters of vagal HRV in the direction of sympathetic dominance, which may cause an increase in cardiovascular risk.

The mechanisms of the emergence of "hot flashes" are actively considered, but still insufficiently studied. A woman's body weight is a modifiable risk factor, that is, amenable to both non-drug and drug correction. Therefore, the relevance of studying this risk factor for hot flashes is high. The purpose of this study is to study the relationship between vasomotor symptoms and body mass index in women. The study included 228 women with vasomotor complaints in the early postmenopausal period. The average age at the onset of menopause was 51.6 years (47.2; 53.4), while the median duration of menopause was 4.1 years (2.2; 5.0). Our results indicate the possibility of hot flashes in women with different body mass index. In obese women, severe menopausal syndrome (MS) is less common (5.7%) than in women with overweight (8.3%) or normal body weight (6.1%); while the average degree of MS is most often observed in patients with normal body weight (21.5%), less often with obesity (14.9%) and overweight (10.1%); mild MS is most often observed in patients with normal body weight (18%), less often with obesity (10.1%) and overweight (5.3%). It was found that in women with obesity, the severity of the initial signs of MS is not high (on average, up to 5-6 hot flashes per day), severe MS is less common than in women with overweight or normal body weight. Thus, hot flashes occur in women regardless of the woman's body weight and "obesity" is not able, as previously thought, to "protect" a woman from the appearance of hot flashes.

The ways of increasing the effectiveness of treatment for adolescents with chronic vulvovaginitis associated with ureamycoplasma infection were studied.

The main role in spontaneous abortion in 2nd and 3d trimesters is assigned to cervical insufficiency. According to a number of researchers, bed rest, elevated lower limbs, restriction of physical activity, tocolysis, antibacterial therapy do not affect the prolongation of pregnancy and are ineffective for preventing premature spontaneous labor. Correction of cervical insufficiency can be carried out by a vaginal form of progesterone, cerclage, pessary. The use of vaginal progesterone is justified in women with recurrent miscarriage, a history of premature birth, and shortening of the cervix to less than 25 mm. Indications for surgical correction are limited to patients with habitual loss of pregnancy due to cervical weakness or a history of premature birth. In the absence of significant obstetric history, cerclage has no advantages over the use of progesterone. The optimal time for cerclage is up to 20 weeks of pregnancy. Unlike progesterone cerclage has complications, the frequency and severity of which are attributable to the timing and indications for correction. Transabdominal cerclage is performed only when there is a technical impossibility of vaginal access due to the absence of a vaginal part of the cervix or after unsuccessful attempts of vaginal cerclages. Most often, the use of a pessary is associated with the diagnosis of a short cervix in terms of more than 24 weeks of gestation in the absence of an aggravated history. The combined use of gestagens, pessary and cerclage does not increase the efficiency of carrying a singleton pregnancy. Methods for the prevention of preterm delivery in multiple pregnancy, such as the introduction of a specialized outpatient service, bed rest, antibacterial therapy, progesterone, preventive cerclage or the insertion of a pessary do not change the incidence and mortality of newborns.

Objective: to study the features of the course of pregnancy and childbirth in HIV-infected women in the Saratov region according to a retrospective analysis of case histories for 2013–2018. Materials and methods. A retrospective clinical and statistical analysis of the course of pregnancy, childbirth and the postnatal period was carried out according to medical records of 282 HIV-infected pregnant women who were treated at the State Agrarian Medical Center (Engels, Saratov Region, Russia) in 2013–2018. (main group). The comparison group consisted of patients who were not infected with HIV who were treated at the SAUS EOC in 2013–2018. To assess the statistical significance of differences, the standard statistical analysis software package STATISTICA 10,0 was used. Results. Compared to 2013, in 2018, the age of HIV-infected pregnant women has decreased (p<0,05). HIV-infected people are less likely to go to a maternity clinic before the 12th week of pregnancy (p<0,05). A high frequency of co-infection of HIV-infected women with urinary infection (p<0,05) and genital tract (p<0,05), hepatitis C viruses (p<0,05) and B (p<0,05), and syphilis was found anamnesis (p<0,05). A high susceptibility of these women to viral infections was noted: acute respiratory viral infection (p<0,05), genital herpes virus (p<0,05), cytomegalovirus infection (p<0,05). The incidence of sexually transmitted infections is high: urogenital chlamydia (p <0,05), trichomonas colpitis (p<0,05). HIV-infected pregnant women have an increased incidence of anemia (p<0,05), chronic pyelonephritis (p<0,05), and skin diseases (p<0,05), and body mass deficiency is more common (p<0,05). In case of HIV infection, the frequency of operative delivery (p<0,05), premature birth (p<0,05), the frequency of formation of a low-weight fetus at a time of gestation (p<0,05), as well as perinatal mortality (p<0,05). The reserve for reducing perinatal mortality for newborns from HIV-infected mothers is in the pregravid period, testing for HIV, hepatitis C virus, correction of the patient’s weight, elimination of the iron deficiency condition, detection and rehabilitation of urogenital foci. When taking to a dispensary account, control and correction of anemia, chronic infectious diseases, monitoring of the state of the vaginal biocenosis are necessary, in the second half of pregnancy — control of fetal growth.

ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского МЗ РФ, Саратов, e-mail: jkovlevaov@yandex.ru Проведен анализ основных проблем беременности после вспомогательной репродуктивной технологии (ВРТ). Подчеркнуто, что бесплодие, как и субфертильность, являются независимыми факторами риска для индукции акушерских осложнений и неблагоприятных перинатальных исходов даже вне ВРТ. Здоровье пары до зачатия вносит свой значительный отрицательный вклад в груз формирования акушерской патологии на протяжении беременности. Установлено, что возраст и высокий уровень эстрогенов являются независимыми предикторами гиперкоагуляции. Доказано, что генетический полиморфизм к тромбофилии не влияет на исход беременности после ВРТ. Тестирование на АФС чаще обнаруживает положительные результаты среди женщин с бесплодием, но не обнаружена корреляционная связь между АФС и исходом после ВРТ. ВРТ ассоциировались с повышенным риском преждевременной отслойки нормально расположенной плаценты, предлежания плаценты, вращения плаценты, vasa previa. Суммированы основные акушерские осложнения со стороны матери, плода и новорожденного. Показана значительная роль ВРТ в возникновении таких осложнений беременности, как плацентарная недостаточность, преэклампсия, многоплодие. Отмечен высокий риск формирования маловесного к сроку гестации плода, недоношенности, массивных кровотечений. Подчеркнуто, что лечение c использованием ВРТ может предрасполагать последующее потомство к повышенному риску хронических заболеваний, влияющих на качество и продолжительность жизни. Ключевые слова: вспомогательные репродуктивные технологии, осложнения беременности, исход для плода и новорожденного

The ways of increasing the effectiveness of treatment for adolescents with chronic vulvovaginitis associated with ureamycoplasma infection were studied.

УДК 618.33/.39ОСНОВНЫЕ ПРОБЛЕМЫ БЕРЕМЕННОСТИ ПОСЛЕ ВРТ Яковлева О.В. 1 , Глухова Т

The goal is to justify the principles of prevention and correction of micronutrient deficiency in mother and child on the basis of a comparative analysis of the health status of pregnant women and newborns in different conditions of provision with vitamins and minerals. Materials and methods. A comparative analysis of the clinical and biochemical results of a survey of 376 mothers and their children in the period of newborns. The study of the content of the main micronutrients in the blood and breast milk, ioduria in mothers, comparison obstetric and perinatal outcomes depending on the availability of women with vitamins and microelements during pregnancy. Results. Data on high frequency of polyhypovitaminosis (72.6%), hypo-microelementosis (19.4-45.2%), iodine deficiency in pregnant women, low concentration vitamins A, B1, B2, C, b-carotenoids, iodine, iron, zinc, selenium in breast milk in lactating, not receiving vitamin-mineral preparations. It is proved that the intake of women from the early stages of pregnancy is a balanced vitamin-mineral complex Elevat® Pronatal and potassium iodide at a dose of 250 mcg/day normalizes their micronutrient supply and significantly reduces the incidence of complications pregnancy, delivery in mothers, diseases and pathological conditions in newborns (in 1.3-3 times, p

The review presents the published data on relevance of problem, frequency rate and the mechanisms of occurrence of premenstrual syndrome, the necessity of complex treatment of premenstrual syndrome has been proved.

Until now, there is no systematic information on the role of endothelial dysfunction in the mechanisms of disorders of blood coagulation potential and microcirculation in different organs and tissues in preeclampsia. Objective : Our aim was to extend the existing principles of diagnosis of pre-eclampsia by establishing the role of endothelial dysfunction in the mechanisms of blood coagulation potential violations. Methods: A prospective comparative study was performed. Condition of coagulation processes studied by conventional techniques, parameters of a functional endothelium (nitric oxide metabolites, endothelin 1, thrombospondin, thrombomodulin and intercellular adhesion molecules in blood plasma) — by ELISA. Results : The study group included 55 patients with moderate preeclampsia and 49 pregnant women with severe pre-eclampsia, in the control group — 40 women with physiological pregnancy. In patients with pre-eclampsia moderate observed increase in plasma endothelin-1 (p <0.001), thrombospondin (p <0.001), intercellular adhesion molecules (p <0.001) while reducing the level of nitrogen oxide (p <0.001), increase in time of fibrinolysis (p <0.050) and decreased international normalized ratio (p <0.050) compared with the control group. With increasing severity of preeclampsia the researchers detected in blood plasma of patients a progressive increase in endothelin 1 (p1 <0.020), thrombospondin (p1 <0.001), intercellular adhesion molecules (p1 <0.001) and decrease of nitric oxide metabolites (p1 <0.001) and thrombomodulin (p1 <0.001); the last combined with the activation of procoagulant hemostasis. Conclusion : There is a pathogenetic relationship between the development of endothelial dysfunction, impaired blood coagulation potential and the severity of clinical signs of preeclampsia. To widen the number of existing techniques to diagnose the severity of pre-eclampsia we recommende to mesure endothelin 1, thrombomodulin, thrombospondin, intercellular adhesion molecules and nitric oxide metabolites in the blood plasma, and use traditional indicators to assess the hemostatic system.

UNLABELLED:Until now, there is no systematic information on the role of endothelial dysfunction in the mechanisms of disorders of blood coagulation potential and microcirculation in different organs and tissues in preeclampsia.OBJECTIVE:Our aim was to extend the existing principles of diagnosis of pre-eclampsia by establishing the role of endothelial dysfunction in the mechanisms of blood coagulation potential violations.METHODS:A prospective comparative study was performed. Condition of coagulation processes studied by conventional techniques, parameters of a functional endothelium (nitric oxide metabolites, endothelin 1, thrombospondin, thrombomodulin and intercellular adhesion molecules in blood plasma)--by ELISA.RESULTS:The study group included 55 patients with moderate preeclampsia and 49 pregnant women with severe pre-eclampsia, in the control group--40 women with physiological pregnancy. In patients with pre-eclampsia moderate observed increase in plasma endothelin-1 (p < 0.001), thrombospondin (p < 0.001), intercellular adhesion molecules (p < 0.001) while reducing the level of nitrogen oxide (p < 0.001), increase in time of fibrinolysis (p < 0.050) and decreased international normalized ratio (p < 0.050) compared with the control group. With increasing severity of preeclampsia the researchers detected in blood plasma of patients a progressive increase in endothelin 1 (p1 < 0.020), thrombospondin (p1 < 0.001), intercellular adhesion molecules (p1 < 0.001) and decrease of nitric oxide metabolites (p1 < 0.001) and thrombomodulin (p1 < 0.001); the last combined with the activation of procoagulant hemostasis.CONCLUSION:There is a pathogenetic relationship between the development of endothelial dysfunction, impaired blood coagulation potential and the severity of clinical signs ofpreeclampsia. To widen the number of existing techniques to diagnose the severity of pre-eclampsia we recommende to mesure endothelin 1, thrombomodulin, thrombospondin, intercellular adhesion molecules and nitric oxide metabolites in the blood plasma, and use traditional indicators to assess the hemostatic system.