The article presents three clinical observations of successful conservative treatment of pregnant women with monochorionic, diamniotic twins (MDT), coming naturally. In all cases, there were manifestations of twin-to-twin transfusion syndrome (TTTS) with progressive blood flow disorders in the utero-placental space with a pronounced delay in the development of one of the fetuses. In the early stages of pregnancy was supposed to terminate the pregnancy, but the women refused. Pregnant women were admitted to the perinatal center at 23, 23 and 24-25 weeks, respectively. During the examination, the diagnosis was confirmed, at the same time in all cases, the patients found manifestations of endotoxicosis and inflammatory response. Pregnant conducted methods of detoxicational (efferent) therapy in the form of photomodification of blood with sessions of laser and ultraviolet radiation in combination: in the first case — plasmaexchange with 5% albumin solution No 6 and the cascading plasmafiltration No 5; in the second observation - with medium volume plasmapheresis No 7, hemosorption No 1; in the 3rd observation – with plasmapheresis No 7, hemosorption No 3. Complications at efferent therapy was not, indices of homeostasis of pregnant women in the dynamics normalized. Blood flow disorders in the placenta persisted, but there was a steady increase in body weight of the fetus. In general, women’s pregnancies were prolonged for 11, 13 and 9 weeks, respectively (in the first two cases, women were even temporarily discharged home). Childbirths in all cases were performed by operational pathway, there were no complications in childbirth and after childbirth in mothers. All six children were born alive with mild and moderate prematurity and did not need long-term intensive care. All were on breast-feeding, in dynamics surveillance caught up with contemporaries in development.
In the article presents data on the management of a 48-year-old patient with HIV infection, urogenital infection with pregnancy, which occurred as a result of IVF, with premature effusion of amniotic fluid at 23 weeks of pregnancy with the syndrome of growth retardation of 2 fetus in monochoric diamniotic twins. After the discharge of the amniotic fluid, the patient was treated for six days in an infectious hospital, then transferred to the perinatal center, where blood tests noted moderatemanifestations of endotoxicosis, increased levels of aminotransferases and an inflammatory reaction of the body. The course of treatment included detoxification methods (plasmapheresis, hemosorption, photomodification of blood with ultraviolet, laser rays), which contributed to the normalization of blood tests, prolongation of pregnancy for another three weeks in the absence of septic complications after operative childbirth in the mother and in newborn girls. At birth, 1 childs weight, body length and Apgar score were 750 g., 29 sm. and3/5points, respectively, in 2 children 590 g., 30 sm. and1/3points, respectively. The children required treatment from resuscitators, at the second stage of nursing, from rehabilitation specialists.
Perinatal infections occupy a leading place among the causes of neonatal morbidity, maternal and perinatal mortality. Infections are among the main causes of termination of pregnancy and premature birth. The practical recommendations presented in the work are intended for doctors of obstetric institutions in order to make a clinical diagnosis of an infection specific to the perinatal period, the tactics of examination and treatment of newborn children. The clinical recommendations correspond to the latest scientific data on the topic, contain information that is applied to the practical activities of a neonatologist, intensive care specialist and pediatrician. These clinical recommendations contain information about infections specific to the perinatal period, including the definition, frequency of occurrence, etiology of infections, pathogenetic mechanisms of disease development Numerous high-risk factors for infection of the fetus and newborn are described in detail. The document discusses and proposes the classification of the disease, the criteria for the adoption of the diagnosis. The features of the clinical picture of the disease are described, it is noted that the inflammatory process in a newborn child can be localized in any organ or acquire a systemic (generalized) character, in some cases, the ingress of an infectious agent into a macroorganism is not necessarily accompanied by clinical manifestations, which indicates an asymptomatic or subclinical course of infection. The recommendations provide advanced laboratory and instrumental diagnostics. The stages of treatment are described, including the choice and correction of antibacterial therapy, taking into account the peculiarities of the mother’s anamnesis, the child’s gestation period and the etiology of the disease. These clinical recommendations have been prepared taking into account the level of credibility of the recommendations and the level of reliability of the evidence.These practical recommendations are offered for public discussion and are posted in full on the website of the Ministry of Health of the Russian Federation.
It is known from the literature that premature amniotic fluid expulsion in 22 weeks 27 weeks 6 days gestation is very dangerous, as it is accompanied by high morbidity and mortality in newborn infants.
Clinical observation. This article presents the results of observing two women with premature amniotic fluid expulsion at 22 and 24 weeks gestation, respectively. In the first case, the woman was immediately admitted to the perinatal center; in the second observation, she was admitted after 3.5 weeks of treatment at another institution. In both cases, pregnant women had manifestations of oligo and endotoxemia, a protective inflammatory response in the mother-placental-fetal system (more pronounced in the second observation) against a background of urogenital infection. In the course of complex treatment, the patients underwent detoxification, of efferent therapy in the form of repeated consecutive sessions of plasmapheresis, hemosorption (one operation each), external photomodification of blood with ultraviolet, laser beams with prolongation of pregnancy by 10 and 8 weeks. The deliveries in both cases were operative with live babies with body weight of 1600 g and 1840 g, respectively. In the first case the infant did not need intensive care, was breastfed, in the second observation the newborn received active respiratory support for 9 days, in the dynamics his condition normalized. No septic complications in mothers and fetuses were observed.
The concluding efferent therapy in course of therapy were effected by prolongating of pregnancy with of good the results for mothers and them of fetus.
BACKGROUND: To date, several options for helping pregnant women with rhesus immunization are known: (a) active tactics in carrying out methods of efferent therapy in the form of basic operations (plasmapheresis, hemosorption) in combination with adjuvant methods (immunoglobulin, blood photomodification with ultraviolet, laser beams, ozone therapy) to pregnant women; (b) wait-and-see active tactics with observation of the pregnant woman, followed by intrauterine intravascular transfusions of washed donor red blood cells; (c) mixed active tactics with a sequential combination, alternation of these methods. In Russia, only option 2 with fetal transfusions of washed donor red blood cells is accepted as the basis and paid for. The objective of the study is to conduct a comparative analysis of pregnancy outcomes in women with rhesus immunization using different management options.
MATERIALS AND METHODS: A total of 392 women were followed up at seven different institutions in Russia and at the Donetsk Center for Maternal and Child Health (DNR), of whom 345 pregnant women (Group 1) received efferent therapy, 33 women (Group 2) had fetuses intrauterine bypass surgery, and 14 pregnant women (Group 3) had mixed efferent therapy and fetal PEEP bypass surgery.
RESULTS: The analysis showed that the most favorable results for the main clinical indicators (premature, operative delivery, fetal hypoxia at birth, etc.) were in Group 1 and 3 women, in which the perinatal mortality was 14.5/1000 and 0/1000, respectively, which was significantly lower than in Group 2 (176.5/1000). It was also found that in Groups 2 and 3 women, the mean intervals between repeated transfusions of washed donor red blood cells were 8.8 0.2 and 21.4 3.8 days (p 0.01), which may be explained by the detoxifying effect of efferent therapy methods, preservation of fetal red blood cells and transfused donor red blood cells to the fetus with prolonged gestation and obtaining healthier and more viable progeny.
CONCLUSIONS: 1. Severe Rh conflict is a manifestation of a syndrome of systemic effects of aggressive metabolites of specific and nonspecific nature. 2. The etiopathogenetic measure in the prevention and treatment of HDF/HDN in rhesus conflict is efferent therapy methods for the mother, and transfusion of washed donor rhesus-negative red blood cells to the fetus is effective, but a temporary, palliative measure, as is the case in multiple organ failure. 3. In the treatment protocols, efferent therapy methods must be present to prevent fetal red cell destruction and, equally importantly, to prevent destruction of Rh-negative donor red cells transfused to the fetus.
The article presents the results of an empirical research on anxiety in pregnant women using the Russian version of the Perinatal Anxiety Screening Scale (PASS-R). The research of 609 women with an average gestation period of 26.76±10.20 gestational weeks showed the presence of anxiety symptoms of various specificity and varying severity according to the PASS-R in 41.87% of respondents. The presence of severe symptoms of anxiety in pregnant women on the scale of specific fears of the pregnancy period is closely interrelated with various complications of pregnancy, with hospitalisation during pregnancy and the presence of indications for abdominal birth. The total level of anxiety in pregnant women is correlated with the presence of difficult adverse life events: problems in relationships with a partner and with relatives, accommodation issues and financial problems.
С переходом российской экономики на рыночные рельсы все субъекты хозяйственной деятельности оказались в принципиально новых условиях функционирования. Будучи связанными новыми обязательствами и получив целый ряд новых свобод, далеко не все предприятия и организации смогли успешно приспособиться к новым экономическим условиям. Но утверждать, что становление и формирование развитой рыночной экономики коснулось лишь отраслей материального производства, принципиально не верно. Бюджетная сфера в свою очередь является неотъемлемым звеном экономической системы страны, а это значит, что развивающиеся рыночные процессы оказывают прямое влияние на состояние всех ее составляющих, включая и систему высшего образования. Необходимо также отметить, что образовательная деятельность, в отличие от других отраслей экономики, является наиболее специфичной. Главная особенность ее в том, что основной целью работы вуза является выполнение социального заказа (подготовка специалистов), а получение доходов от внебюджетных операций и формирование прибыли выступает скорее единственной вспомогательной функцией, позволяющей вузу в рыночных условиях обеспечить нормальное осуществление своих первоочередных задач. В статье рассматриваются методы привлечения финансовых средств, даются рекомендации как объединить интересы предприятий, компаний и вузов в решении проблемы соответствия качества подготовки специалистов в вузах требованиям, предъявляемым к ним рынком труда, отвечающим полезности для предприятий выпускаемых вузом специалистов.
Previous studies implicated cardiotonic steroids, including Na/K-ATPase inhibitor marinobufagenin (MBG), in the pathogenesis of preeclampsia (PE). Recently, we demonstrated that (i) MBG induces fibrosis in rat tissues via a mechanism involving Fli1, a negative regulator of collagen-1 synthesis, and (ii) MBG sensitive Na/K-ATPase inhibition is reversed by mineralocorticoid antagonists. We hypothesized that in human PE elevated MBG level is associated with the development of fibrosis of the umbilical arteries and that this fibrosis can be attenuated by canrenone. Fifteen patients with PE (mean BP = 118 ± 4 mmHg; 34 ± 2 years; 38 ± 0.3 weeks gest. age) and twelve gestational age-matched normal pregnant subjects (mean BP = 92 ± 2 mmHg; 34 ± 1 years; 39 ± 0.2 weeks gest. age) were enrolled in the study. PE was associated with a higher plasma MBG level, with a four-fold decrease in Fli1 level and a three-fold increase in collagen-1 level in the PE umbilical arteries vs. those from the normal subjects (p < 0.01). Isolated rings of umbilical arteries from the subjects with PE exhibited impaired responses to the relaxant effect of sodium nitroprusside vs. control vessels (EC50 = 141 nmol/L vs. EC50 = 0.9 nmol/L; p < 0.001). The effects of PE on Fli1 and collagen-1 were blocked by the in vitro treatment of umbilical arteries by 10 μmol/L canrenone. Similar results were obtained for umbilical arteries pretreated with MBG. These data demonstrate that elevated MBG level is implicated in the development of the fibrosis of umbilical arteries in PE, and that this could be blocked by mineralocorticoid antagonists.
