[Development and practical implementation of organ preservation surgery in case of placenta accreta in patients with a scar on the uterus].

Comparative analysis of methods for preventing/stopping intraoperative hemorrhage during surgical delivery of patients with placenta accreta (temporary balloon-assisted occlusion of common iliac arteries, internal iliac artery ligation; uterine artery embolization - UAE) has shown that internal iliac artery ligation is not effective. UAE and especially balloon-assisted occlusion of common iliac arteries have demonstrated a significantly greater effect due to the temporary 'devascularization' of the uterine corpus. It has been proved that an innovative surgical technique - a lower segment Caesarean section (LSCS) significantly reduces intraoperative blood loss. The main purpose of an alternative uterus cut - anterior placenta previa preserving and bleeding absence before the child removal - has been achieved within all observations. LSCS has caused a significantly smaller (by 1.6 times) amount of intraoperative blood loss than the corporal one. Another innovative surgical technique is metroplasty. It entails removing placenta accreta areas from the uterus with subsequent restoration of the organ integrity. The authors have proved the necessity of autologous advance blood donation and hemodilution strategy, which was first implemented in Moscow Center for Family Planning and Reproduction, and after 2006 was used in all obstetric institutions in Moscow. This allowed reducing the number of blood donations up to 85% and additionally decreased transfusiological risks which is economically valuable as well. Improvement of diagnostic methods, operating techniques, hemostasis, blood volume redistribution and creating an algorithm on its basis has proved the possibility of implementing an organ-, life, health- and fertility preserving approach in cases of placenta accreta in patients with a scar on the uterus after cesarean section. The introduction of the enhanced principles of patient management with placenta accreta has significantly reduced the number of hysterectomies in Moscow (from 48 in 2007 to 8 in 2016), and during the last 2 years no patient with this complication has had a hysterectomy. 12 out of 85 patients who had deliveries in accordance with the developed algorithm, have realized their subsequent fertility.

[The results of primary audiological examination of the children presenting with intrauterine growth retardation and normotrophics born after multifetal and singleton pregnancies].

The objective of the present work was the comparative study of the state of the acoustic analayzer in the full-term and premature infants born after multifetal (MP) or singleton (SP) pregnancies with the body weight at birth corresponding to the gestational age (normotrophics) and presenting with intrauterine growth retardation (IUGR). The method of distortion product otoacoustic emissions (DPOAEs) was employed in the study. It has demonstrated that the normotrophic babies born at the gestational age over 34 weeks after singleton pregnancy pass the DPOAEstest significantly more frequently than normotrophics of the same gestational age born after multifetal pregnancy. Moreover, the unilateral impairment of hearing in the full-term infants born after multifetal pregnancy occurs more frequently than in those born after singleton pregnancy.

[The evaluation of the hearing function in the premature infants with intrauterine growth retardation during the third and sixth months of life by recording auditory steady-state response].

The objective of the present work was to study the function of the retrocochlear auditory pathway in the premature infants with intrauterine growth retardation (IGR) in comparison to that of the normotrophics of a similar gestational age during the third and sixth months of life by recording auditory steady-state responses (ASSR). The audiological examination by the method of auditory steady-state response (ASSR) involved 127 children at the 3d month of life and in 97 children at the 6th month of life. It was shown that the ASSR thresholds at certain frequencies during the 3d and 6th months of life of the children born after the 32d week of pregnancy were significantly higher than in the children born after 32 weeks gestation. The comparison of the two objective audiological methods, viz. distortion-product otoacoustic emission (DPOAE) and ASSR, indicates that both should be used to evaluate the hearing function during the third and sixth months of life to compensate for the discrepancy between the results obtained by either technique.

[The hearing function in the one-year old children with intrauterine growth retardation evaluated by two objective audiological methods].

The objective of the present study was to collect objective information about the hearing function in the prematurely born infants suffering intrauterine growth retardation (IUGR). The audiological examination of 77 patients at the age of 12 months was performed using two different methods making use of distortion product otoacoustic emission (DPOAE) and evoked auditory steady state responses (ASSRs). Hearing disorders were diagnosed in the children presenting with grade II and III IUGR born prior to the 34th week of pregnancy. The results of the study indicate that the children with grade II and III intrauterine growth retardation born earlier than the 34th week of pregnancy are at risk of developing hearing impairment and should be under dynamic audiological observation with the use of two objective methods, namely DPOAE and ASSR.

[Changes in auditory function during first 6 months in premature children with intrauterine growth retardation].

AIM: To define an influence of intrauterine growth restriction to forming of hearing function of preterm infants. PATIENTS AND METHODS: The audiological test by the method of distortion product otoacoustic emission (DPOAE) was performed 3 times (during supposed dates of birth; 3 months old; 6 months old) in 136 premature children born while different gestation periods. Children were divided into 2 groups: premature children with intrauterine growth restriction (IUGR) and premature children with normal weight for their gestation age (normotrophy). RESULTS: During checkup in supposed date of birth of children with IUGR, DPOAE was detected less than children with normotrophy and with the same gestation period. Test results in all 3 months old premature children of gestation period less than 32 weeks were significantly lower in comparison with children of another date of gestation. Results in 6 months old children with IUGR and with normotrophy were almost identical. In 17% of children with IUGR born at term gestation less than 32 weeks of auditory function is not available. Children with normotrophy from the same subgroup lack of auditory function were noted in 12% of cases. CONCLUSIONS: Premature children with IUGR maturing of auditory function is likely not to end in 6 months and can continue after 6 months.

[Perinatal hypoxic CNS lesions in neonates]. / Perinatalnye gipoksicheskie porazheniia TsNS u novorozhdennykh.

The paper reviews the causes of perinatal brain lesions, shows the involvement of disturbances of cellular membrane structural and functional properties and blood-brain barrier permeability in the pathogenesis of hypoxic CNS lesions for neurospecific proteins. It also provides evidence for the principles of management of pregnancy, labor and early neonatality at a risk for cerebral abnormalities to reduce childhood disability.

[Biophysical activity of the fetus during labor in EPH-gestosis]. / Biofizicheskaia aktivnost' ploda v rodakh pri OPG-gestoze.

Fetal respiratory and motor activities were studied in 105 parturients with EPH gestosis of varying severity and in 25 reference ones. The results evidence that, in contrast to the antenatal period, normal fetal condition in labor is associated with biophysical inertness, this fact confirming the known viewpoint on the intranatal fetal hibernation. Active management of labor in parturients with doubtful and abnormal biophysical parameters on the eve of delivery impairs the natural mechanisms of fetal defense in labor. Respiratory or motor activity of the fetus should be regarded as a prognostically unfavorable sign in respect of hypoxic involvement of the CNS and the newborn aspiration syndrome.

[Possibility of predicting intrauterine fetal growth retardation by a single ultrasonic examination (using varying standards)]. / Vozmozhnost' prognozirovaniia zaderzhki vnutriutrobnogo razvitiia ploda po odnokratnomu ul'trazvukovomu issledovaniiu (s ispol'zovaniem skol'ziashchikh normativov).

The paper deals with early prediction of fetal growth retardation and its severity in a newborn from single ultrasound fetal biometric findings (biparietal head size, chest and belly diameters) at week 20 of pregnancy. The prediction was made by employing the developed varying standards for these parameters as percentile curves and tables. A stepwise prediction of fetal growth retardation was proposed for obstetric in- and outpatient settings, which was presented as an IBM personal computer dialogue program. The positive diagnostic value of fetal growth retardation prediction was found to be 69.7%, its negative value was 86.9%. The paper discusses whether therapeutic measures and pregnancy length affect the efficiency of its prediction and stresses that the prediction is valuable for individual well-grounded tactics for pregnancy management.

[Fetal biophysical profile in EPH gestosis]. / Biofizicheskii profil' ploda u beremennykh s OPG-gestozom.

Fetal biophysical profiles (FBP) have been obtained in 111 women with toxemia of pregnancy at 34-42 weeks. Six biophysical parameters were tested: nonstress test, fetal respirations, motility and tone, amniotic fluid volume and placental maturity. The test findings were compared with pregnancy outcomes, controlling for intrapartum fetal distress. Apgar scores, intrauterine growth retardation, postdate gestation and symptoms of early neonatal adaptation, fetal or neonatal death. The values of FBP were lower with higher severity of gestational toxemia, with the greatest incidence of poor perinatal outcomes in the presence of complicated delivery.

[Treatment of fetal hemolytic disease by hemosorption]. / Lechenie gemoliticheskoi bolezni ploda metodom gemosorbtsii.

Hemosorption was used in the combined treatment of fetal hemolytic disease (FHD) for the first time. It was demonstrated that hemosorption was a method of choice in pregnant females with manifest sensitization and a history of stillbirth resulted from an edematous type of the disease. A decrease (by a factor of 10(2) to 10(6] in the Rh antibody titers in the blood of the pregnant after hemosorption, and reversibility of echocardiographic signs of FHD, and normalized fetal cardiac performance were regarded as a beneficial prognostic sign. The authors suggested that hemosorption should be started at weeks 24-25 of pregnancy in the absence of echographic signs of the disease. The interval between the sessions should not exceed a fortnight. The treatment course should be completed 1-2 weeks prior to the labor. As part of combined treatment, hemosorption contributed to a reduction in mortality rates (from 81 to 41%) from the edematous type of the disease.

[Ultrasonic placentometry in pregnancy]. / U'ltrazvukovaia platsentometriia vo vremia beremennosti.

The authors developed mathematical formulas for the determination of the size of the placenta during the pregnancy based on the technique of ultrasonic scanning. Healthy pregnant females with 19-40 weeks of gestation underwent ultrasonic placentometry. Reference placental volumes were defined. The authors demonstrated an increment in the placental volume and its growth rate with evolving pregnancy.

[Cesarean section in reducing perinatal mortality and morbidity]. / Kesarevo sechenie v snizhenii perinatal'noi smertnosti i zabolevaemosti.

The practicability of expanding indications for cesarean section in order to reduce perinatal mortality and possible prevention of perinatal losses by the correct choice of the method of delivery have been assessed through the analysis of the performance of Moscow hospitals. Perinatal mortality and morbidity can be reduced through means other than expanding indications for cesarean section. Further studies are needed to improve the management of labor and standards of neonatal care, particularly so for preterm infants.