Vol 6, No 3 (2019)

This review highlights the features that affect fertility and pregnancy in women with eating disorders, possible complications and clinical management of such patients by an obstetrician-gynecologist. Such obstetric and gynecological aspects associated with eating disorders as fertility disorders, unplanned pregnancy, intrauterine growth retardation, miscarriage and premature labor, deficit of lactation and others are considered. We also describe the influence of pregnancy on the course of eating disorders: the possibility of remission, followed by a high risk of relapse, postpartum depression and anxiety disorders. Moreover, we talk about the necessity of screening eating disorders among women of reproductive age and the importance of multidisciplinary management of pregnancy in such patients.

The article presents data on the therapeutic properties of sulphide-silt mud “Tinakskaya” extracted from the Healing Lake located in the Astrakhan region of the Russian Federation. Data on the positive effect of this mud in the treatment of various diseases are presented. The perspectivity of more active use of sulphide-silt mud “Tinakskaya” in gynecological practice is shown.

Abortion occupies a leading place in the structure of reproductive losses. The purpose of the study is to assess the structure and frequency of abortions in the Tula region Russia. Material and methods. In the period from 2013 to 2017, the analysis of the dynamics of fertility and abortion in the period up to 22 weeks was carried out. Results. During 5 years in the region of 73 517 was born living children. The analysis showed that the number of termination of pregnancy was 25 126, of them in the early stages (up to 12 weeks) 23 396 (93.1%), in the period from 12 to 22 weeks - 1730 (6.9%). The number of abortions in the region to 22 weeks decreased from 47.9 to 29.4 per 1,000 women (15-49 years) and from 19.9 to 11.4 per 100 born alive and dead. Compared with other types of abortion, the lowest basic rate of decline (9.97%) was set for spontaneous abortion (9.97%), the highest for medical legal abortion - 62.11%. In the structure of termination of pregnancy up to 12 weeks there was an increase of spontaneous abortion for 2015 -2017 (the basic growth rate of 16.6%). In the region, there was an increase in the frequency of abortions in the first pregnancy by 33.9% and an increase in abortions for medical reasons by 16.85%. The age ratio of abortions remains stable throughout the follow-up period. Conclusion. The structure of reproductive losses in the region is still dominated by medical legal abortions, but among the true prenatal losses the leading role belongs to spontaneous abortion. Reducing the frequency of spontaneous abortion is the main unconditional reserve to increase the reproductive potential of the region.

The aim of the study is to compare the effectiveness of the use of hormonal drugs before hysteroresectoscopic ablation of the endometrium in premenopausal patients with abnormal uterine bleeding. Were examined 145 women aged from 45 to 54 years with recurrent endometrial hyperplasia, which were divided into three groups depending on the preoperative use of one of the hormonal drugs (gestagen preparation, microdose estrogen-gestagen contraceptive, gonadotropin-releasing hormone agonist - GnRHa). When medication-induced endometrial atrophy was achieved, the patients underwent hysteroresectoscopic endometrial ablation using the coagulation vaporization technique. The results of the study showed the feasibility of preoperative thinning of the uterine mucosa to improve the results of treatment of its benign changes. The most effective means for accelerating the attainment of drug regression of the endometrium were GnRHa, whose effectiveness was 95.7%. The estrogen-gestagen-containing contraceptive and gestagen preparation showed an efficacy of 65.3% and 42.8%, respectively. The results of the study should be considered when choosing the optimal tactics for management of premenopausal patients with abnormal uterine bleeding.

The study confirmed that reproductive age patients with endometrial hyperplasia with initial severe hyperestrogenemia, autonomic regulation imbalance, and pronounced psychosomatic disorders as hormonal therapy showed marvelone in the prolonged mode, because in this case the gradient of estrogen incidence is smoother than during application depot forms of buserelin. In addition, the possibility of simplifying the algorithm for applying a verifiable clinical-psychological approach through the use of simple, automated physiological and psychodiagnostic research methods, which makes it possible to effectively use this algorithm in polyclinic conditions, is shown.