Vol 5, No 1 (2018)

In the article, there are considered questions of physiological changes of the blood volume status during pregnancy, parturition and in the postpartum period, features of functional and structural changes of the cardiovascular system. The determination of the circulating blood volume is still a stumbling block for obstetrician-gynecologists and anesthesiologists-resuscitators. Our view of the normal blood volume status during pregnancy is important in light of the assessment of the blood loss in the development of massive obstetric hemorrhage. The doctor needs to know what changes in the cardiovascular system are physiological and which are pathological in case of blood loss, with taking into account the functional changes in the heart that occur during pregnancy, parturition and in the earliest postpartum period. A deeper understanding of this problem will help the doctor avoid aggressive infusion therapy, which can lead to complications.

The article presents a new surgical method for correcting posthisterectomic genital hernia, accompanied by bilateral paravaginal defects. Despite the use of many surgical techniques and high-tech materials for the prevention and treatment of posthisterectomic genital hernia, the prevalence rate of this pathology fails to decline, but on the contrary, for many reasons, it tends to grow, which calls for the development of new surgical methods of the treatment. The proposed surgical program of multilevel correction of posthisterectomic genital hernia with bilateral paravaginal defects, providing multifocal fixation of anatomical structures with polypropylene implants, will improve clinical results and their duration, as well as the fall of the prevalence rate of relapses of the disease.

Infectious diseases are still one of the main causes of perinatal losses worldwide. The consequences for the fetus and the newborn vary from asymptomatic infection to sepsis, malformations and the fetal death. Examination of pregnant women for the presence of infectious agents is an important part of the antenatal care program. The purpose of the work was to assess the structure of infectious screening in various medical institutions in Moscow, as well as the comparison of the recommended in Russia examinations with the main programs of antenatal monitoring in the world. Material and methods. The retrospective study was executed on the basis of four medical institutions: two state women’s clinics and two commercial clinics (the total number of patients - 902 people). The comparison was made with antenatal care programs of the antenatal observation in Centers for Disease Control and Prevention (CDC), 2015 (Centers for Disease Control and Prevention) in the United States of America, and the National Institute for Health and Care Excellence (NICE), 2017 (National Institute for Health and Medical Quality assistance), Great Britain. Results. Basic screening of pregnant women for infection in the Russian Federation includes 8 items (serological study of the blood for syphilis, HIV, hepatitis B and C, rubella, toxoplasmosis, microscopic examination of genital secretions on Neisseria gonorrhoeae and fungi of the genus Candida), which is significantly higher than in the USA and Great Britain (5 and 4 respectively). According to the results of our study, the volume of the compulsory examination of pregnant women is wider than abroad, due to serological examination of blood for the presence of antibodies to cytomegalovirus (CMV) and herpes simplex virus (HSV) of types 1 and 2, microbiological examination of genital secretions, molecular biological diagnosis (polymerase chain reaction - PCR, real-time PCR). Conclusion. Screening of pregnant women for infection in public and commercial clinics has a number of differences. The actual scope of the survey is higher than recommended by the state. The Russian list of tests in comparison with foreign analogs is much wider in terms of the number of nosologies and the frequency of the research. It is necessary to conduct multicenter epidemiological studies throughout the Russian Federation to create optimal regional programs for examining pregnant women for infection that meet the criteria for effective screening.

Massive hemorrhage and hemorrhagic shock as main causes of deaths in pregnancy, occupy up to 25% in the structure of mortality rate in obstetrics. In the past decade, the decline in the share of deaths of mothers has occurred due to postpartum bleedings and bleedings in detachment or placenta previa. The aim of the study was to determine the frequency and structure of massive bleedings in a high-risk group obstetric hospital. Methods. A retrospective descriptive cohort study was executed in 2 stages: at the 1st stage - a study of 396 deliveries histories with main nosological forms leading to possible pathological hemorrhage, in the II stage - analysis of 55 cases of massive blood loss. The object of the study was puerperas with placenta previa; puerperas with deliveries complicated by hypotonic bleeding or premature detachment of the placenta; puerperas with the massive blood loss. Duration of the study: from 01.01.2011 to 31.12. 2015. Results. The most frequent nosological form leading to abnormal blood loss is premature placental abruption. The frequency of cases of massive blood loss (more than 1000 ml) is 0.28% of the total number of deliveries and is more common in primigravidae (56.4%), mainly during surgical delivery (88%). Out of all massive bleedings, 45.5% are due to uterine hypotension. Amputation of the uterus was performed in 18.2% of the number of all cases of the massive hemorrhage. Conclusion. The high prevalence rate of the premature detachment of the placenta is explained by the uncontrollability of this pathology, in contrast to hypotonic bleeding in the postpartum period. The organ-preserving management in massive obstetric hemorrhages is not widely used.

The problem of the increase in the frequency of Cesarean section delivery has not been resolved yet. Firstly, a large variation in the initial state of puerpera, secondly, a wide variety of indications to the operation fail to allow revealing main determinants. In order to develop and implement effective measures to reduce the rate of the abdominal delivery, an understandable, logical classification of patients is necessary. The World Health Organization recommends the use of Robson Ten-Group Classification System. This study executed with the use of the Robson scale reveals the contingent of patients in whom the decline in the frequency of abdominal deliveries is possible. The authors propose a set of measures aimed at reducing the rate of Cesarean section in institutions of the second level.