[Multiple ruptures of major vessels and womb in a parturient woman with Ehlers-Danlos syndrome]. / Mnozhestvennye razryvy magistral'nykh sosudov i matki u rozhenitsy s sindromom Élersa-Danlosa.

Presented herein is a clinical case report demonstrating uncontrolled development of fatal complications in a young parturient woman with vascular Ehlers-Danlos syndrome. The disease had not been known previously. In the third period of natural term delivery we revealed a complete linear vertical uterine rupture with a clinical picture of haemorrhagic shock. After hysterectomy we encountered sequential ruptures of the iliac veins, arteries, abdominal portion of the aorta and inferior vena cava. Attempts at restoring the integrity of vessels followed by ligation thereof, terminating in cutting of vascular walls, with the appearance of new sources of bleeding. The diagnosis was later on verified by the findings of autopsy and genetic typing.

Morphological characteristics of endometrium in patients of reproductive age with viral hepatitis type C.

AIM: The purpose of the study was to investigate the morphological features of endometrium in patients with viral hepatitis type C. MATERIALS AND METHODS: A morphological survey was conducted involving endometrium sections stained with hematoxylin and eosin and Van Gieson's picrofuchsin collected from 140 women of reproductive age, among them 70 patients were diagnosed with chronic hepatitis type C (CHC) infection with minimal (40 patients) and moderate activity (30 patients), and 70 women suffered from endometrial proliferative diseases without viral hepatitis (comparison group). In addition, 36 women with CHC and 36 women without CHC underwent immune histochemical test (IHC) of paraffin sections aimed at investigating the expression level of estrogen (ERα) and progesterone (PR) receptors and proliferation marker Ki-67. Endometrial biopsy samples were collected on the 10th to 14th day and the 15th to 18th day of the menstrual cycle. RESULTS: Focal changes of endometrium in the form of uneven entering of the endometrium into the next phase of the menstrual cycle with the dominating proliferative phase were found in chronic hepatitis C patients. The number of patients having proliferative activity in the endometrium combined with inflammation increased as viral hepatitis became more active. Immune histochemical test showed the prevalence of the expression levels of ERα and PR receptors in the endometrial stroma. Increased expression of Ki-67 was observed mainly in the glandular epithelium and accrued together with the increment in the CHC activity. CONCLUSION: Endometrial pathology in patients of reproductive age with chronic hepatitis type C is characterized primarily by proliferative forms with the increasing mismatch between the nature of structural changes and mucous phase of the menstrual cycle prompting suggestions that direct effect of hepatitis C virus on endometrium is possible.

[INCREASING EFFICACY OF PREGRAVIDAR PREPARATION IN MARRIED COUPLES SUFFERING OF INCREASED RISK OF PREGNANCY MISCARRIAGE.]

This study was aimed at revealing clinical and laboratory peculiarities in the health of married couples suffering of pregnancy miscarriage and the possibility of correcting this state by preconception therapy with reamberin, based on analysis of the results of observations and investigations for 196 married couples. At the first stage, we have studied the influence of provoking factors on the miscarriage during first trimester, including the presence and degree of chronic nonspe- cific intoxication. The patients were divided into groups: first (main) group including 40 couples, in which the pregnancy was complicated by the risk of pre- gnancy termination in the first trimester and second (comparison) group of 74 couples, in which abortion in the first trimester was followed by complex precon- ception therapy. The control group included 82 couples with normal course of pregnancy in the first trimester. At the second stage, we have studied the efficacy of including reamberin in the scheme of therapy. For this purpose, patients in the second (comparison) group were separated into subgroups. In subgroup I, 50 male patients received reamberin (i.v., dropwise, 400 mL per day at a rate of 60 - 70 drops/min, over 10 days), while 24 male patients of subgroup II were treated according to commonly accepted schemes (involving recommendations concerning regime and diet, psychological aid, and polyvitamins in prophylac- tic doses). Analysis of the obtained data revealed the presence of nonspecific intoxication in patients of the main group comparison groups, which was related to the increased level of intermediate metabolism products and osmotic state of plasma, and disorders in the hepatobiliary system as manifested by hyperbiliru- binemia, increased level of transaminases, urea, creatinine, etc. In addition, most patients also exhibited changes in spermograms, including astenozospermia (75.9 ? 7.9%) and teratozospermia (69 ? 8.6%) on the background of relative androgenous insufficiency, and bacterospermia in 26.7 ? 8.1% of patients from couples where the pregnancy of females was complicated by risk of miscarriage in the first trimester, and in 34.3 ? 5.8% of patients from couples receiving re- habilitation care upon abortion in the first trimester. The inclusion of reamberin in the scheme of complex preconception therapy of male in pairs with miscarri- age problems increased the efficacy of therapy. This was manifested by decrease in the parameters of intoxication (on the average by 21 % (d = 0.017), positive dynamics of the main indices of spermograms, and improvement of the general state, which led in turn to increased probability of the onset and maintenance of pregnancy.