Estimation to efficiency of the multifunction method оf endometriosis ovariеs treatment.

OBJECTIVE: The aim: The aim of the study was to improve the results of treatment of patients with endometriosis by using a combination method of therapy. PATIENTS AND METHODS: Materials and methods: For two years, 136 women of reproductive age who underwent laparoscopic surgeries for ovarian endometriosis were monitored: Group I (n = 24) did not receive any hormonal treatment in the perioperative period; Group II (n = 32) - received gonadotropin-releasing hormone agonists within 3 months after surgery; Group III (n = 80) prior to laparoscopic removal of the ovarian cyst used gonadotropin-releasing hormone agonists - Triptorelin 3.75 mg intramuscularly for 2 months, as well as three months after surgery. The control group consisted of 30 healthy women of reproductive age with regular menstrual periods. All patients underwent transvaginal ultrasound, counting the number of antral follicles before and after treatment. Serum hormone levels (FSH, prolactin, thyrotropic hormone, anti-Mullerian hormone, inhibin B) were determined by enzyme-linked immunosorbent assay on Cobas e-411 analyzer (Roche Diagnostics, Switzerland) on day 2-3 of the menstrual cycle and on day 2-3 of the first menstrual period after the end of treatment. Laparoscopic removal of the cyst was performed with exfoliation of the cyst, hemostasis on the wound surface of the bed of the cyst was performed with a bipolar electrocoagulator. Bipolar coagulation and resection of the ovarian tissue with no potential was used during surgical treatment of the ovaries, which made it possible to preserve the intact portion of the ovary as much as possible. RESULTS: Results: Analysis of ovarian reserve indices, namely number of antral foliculs, number of antral follicles, AMG, and inhibin B levels in all examined patients with ovarian endometriomas were significantly lower than those of the control group before the start of treatment: in the ovarian endometrial group group 1.26 times (p <0.01), inhibin B - 1.5 times (p <0.01), the number of antral follicles - 1.2 times (p <0.01), due to the development dystrophic changes of the follicular apparatus due to prolonged compression, hypoxia, fibrosis in the ovaries. Patients who planned pregnancy were advised to have an active sexual life before menstruation was restored. In 23 (46.9%) of 49 patients who had reproductive plans, pregnancy occurred without first menstruation after a course of gonadotropin-releasing hormone agonists, 12 (24.5%) women became pregnant during the first three menstrual cycles. Extracorporeal fertilization was recommended for women who did not have pregnancy within 6 months of surgery. For two years in women who did not plan pregnancy, recurrence of endometriosis was not observed. CONCLUSION: Conclusions: The combination of laparoscopic treatment with gonadotropin-releasing hormone agonists in patients with endometriosis with infertility allowed to restore reproductive function in 71.4% of women, which indicates the effectiveness of the treatment method used. In addition, it helps to achieve lasting remission and addresses the socio-social problems of women's health and maternity.

Methods of preventive intervention in women with multiple pregnancies in non-assymptomic circulation.

OBJECTIVE: The aim: The purpose of the study is a comparative evaluating the effectiveness of using the different methods of treatment of miscarriage in multiple pregnancies taking into account the condition of the cervix. PATIENTS AND METHODS: Materials and methods: 86 pregnant women with diarrheal twins were monitored. On the basis of studying the premorbid background, somatic and reproductive history, features of the gestational period, leading antenatal risk factors for the development of complications in multiple pregnancies were identified. With the help of transvaginal cervicometry the prognostic ultrasound criteria of the condition of the cervix and its obstructive capacity in case of premature birth are investigated. RESULTS: Results: In the event of uncomplicated pregnancy multiple birth is characterized by a gradual shortening of the cervix in dynamics from 43.2 ± 3.9 mm to 38.2 ± 4.0 mm by 20 weeks, from 37.7 ± 4.1 mm to 30.2 ± 3.9 mm to 30 weeks, to 21.1 ± 3.1 mm to 37 weeks. In the period of 25-27 weeks, the appearance of a V-shaped opening of the uterine cervix in half of the women was observed, which remained until the end of gestation. Shortening of the cervix was the most significant in patients with the risk of abortion who received only tocolytic therapy. In the 2nd trimester revealed a V- or U-shaped opening of the cervical canal. In pregnant women at risk who had an obstetric pessary, a decrease in the length of the cervix was found, which was similar to the rate of its shortening in uncomplicated multiple pregnancies. The condition of the cervix in the presence of a pessary before delivery probably did not differ from the condition of the cervix with the normal course of multiple pregnancies. CONCLUSION: Conclusions: Pregnant women with uncomplicated multiple pregnancies revealed a decrease in the length of the cervix with an increase in gestation. At the end of pregnancy, the internal jaws acquired a predominantly Y-shape. In pregnant women with the risk of pregnancy termination who received tocolytic therapy, the cervix was the shortest. In late gestation, V- and U-shaped internal jaws were observed. Changes in the cervix after the placement of obstetric pessaries are similar to changes in uncomplicated pregnancy.

Basic clinical and pathogenetic aspects of developing the complications during multiple pregnancies.

OBJECTIVE: Introduction: In order to evaluate the value of the Placenta Growth Factor (PlGF) in the developing the gestational complications during multiple pregnancies, a study of this indicator in serum of 320 pregnant women with multiple pregnancies in the first trimester, as well as 40 pregnant women with single pregnancy, constituted a control group. The aim: of the study is to investigate the effect of the placental growth factors on gestational process during multiple pregnancies. PATIENTS AND METHODS: Materials and methods: A prospective study of maternity pregnancy in 320 females with multiple pregnancies was conducted, which comprised the main group of the subjects and 40 healthy women with unipolar pregnancy. The level of PlGF in serum was determined by solid phase enzyme analysis using monoclonal antibody sets in the first trimester of pregnancy. Indicators of the hemostasis system (vascular thrombocyte and coagulation link) were evaluated according to generally accepted methods. Dopplerometry of placental and fetal blood flow was performed in uterine arteries, arteries and umbilical cord veins, middle cerebral artery of the fetus. RESULTS: Results: Women with multiple pregnancies are at the risk of gestational complications - premature births in 67.8% (p<0.01), feto placental dysfunction, pre eclampsia - in 17.5% (p <0.05) cases. The revealed violations of the vascular thrombocyte and coagulation homeostasis in the first trimester of pregnancy are the main risk factors for early premature abortion. It has been shown that the low level of placental growth factor in serum of pregnant women with multiple pregnancies in the case of premature labor, feto placental dysfunction and pre-eclampsia (111.23 ± 8.4, 203.24 ± 6.4 and 305.86 ± 7.4 pg / ml) compared with the corresponding indicators for single-pregnancy (418.2 ± 10.4 pg / ml) is a prognostic marker for the development of gestational complications. CONCLUSION: Conclusions: Timely medical correction of gestational complications during multiple pregnancies with the use of micronized progesterone, low molecular weight heparins, angio protectants allowed prolonging the pregnancy with mono choric type of placentation by 3.2 weeks (up to 34.2 ± 2.4 weeks), and in the case of dichoric twins - to full-term pregnancy.