Vol 20, No 4 (2018)

Abnormal uterine bleeding (AUB) is one of the most common frequent reasons for contacting a gynecologist and conducting intrauterine interventions. AUB causes iron deficiency anemia and a decrease quality of life of women, which in turn is the reason of their social and clinical significance. Based on the analysis of literature and international data recommendations, the review outlines the basic principles of AUB diagnosis, non-hormonal and hormone therapy Advantages of continuous regimen for the administration of progestogens, in particular the LNG-IUS, and COCs containing estradiol valerate, to reduce menstrual flow blood loss are presented in the article. The need for a differentiated approach of choosing the therapy based on age, causes of bleeding, and balance benefits and risks of medicines.

Preeclampsia is considered one of the most serious diseases of pregnancy and cause serious complications in the mother and fetus. The emergence and development of preeclampsia is due to the violation of placental processes. The literature data on microscopic changes in the structure and vascularization of placental villi in preeclampsia are analyzed. Violations of the structure and vascularization of villi placenta in preeclampsia are noted. This, undoubtedly, indicates their role in the development and progression of this complication of pregnancy. Lower values of the extent, surface area and volume of villi, as well as their degree of vascularization, are registered in observations of early preeclampsia. The ambiguity of the data of morphometric and stereo metric indices of villi, which are available in the literature, is most likely due to the investigation of placentas at various stages of gestation and with varying degrees of severity of preeclampsia. An important link in the pathogenesis of preeclampsia and a factor in violations of the villi development is a change in the levels of pro-angiogenic and anti-angiogenic factors, mainly the vascular endothelial growth factor and its receptors. For a complete analysis of the causes and characteristics of preeclampsia is necessary to conduct a comprehensive macroscopic and microscopic examination of the placenta.

Changes in consideration of etiology and pathogenesis of hyperplastic endometrial processes allowed to claim that their preventive maintenance using modern hormonal contraceptives may significantly reduce the frequency and volume surgical treatment. The main protections are ovulation suppression COC mechanism and suppression folliculogenesis, i.e. monthly do not always adequately cyclic processes in endometrium.

It is known that adrenal insufficiency (AI) is a severe life-threatening disease due to the exceptional role of glucocorticoids and mineralocorticoids in the human body. At the same time, according to some reports, the deficit of androgens synthesized by the adrenal cortex (dehydroepiandrosterone - DHEA and dehydroepiandrosterone sulfate - DHEAS) is associated with an increased risk of death, including increased risk of adverse cardiovascular events, development of osteoporosis, diabetes mellitus and malignant neoplasms. The main source of DHEA and DHEAS in females are adrenal glands, so women with hypocorticism have significantly reduced (down to undetectable) levels of these hormones. However, due to lack of a reliable evidence and, accordingly, clinical recommendations, correction of androgen deficiency in patients with AI is usually not performed. The review discusses the accumulated data on the physiological significance of DHEA and DHEAS, their role in the development of various pathological conditions, as well as safety and efficacy of these drugs.

How to make a pregravid women with the stood pregnancy in the anamnesis is the key to success in the fight against miscarriage. The testing outside of pregnancy, the identification of reasons for stopping a previous gestation, adherence to medical recommendations in the programme of preparation for future conception and implantation is a required step in the management of women who have had non-developing pregnancy. Periconceptional prevention is effective only at its beginning 3 months before conception and in the early stages of development of the embryo and fetus (12 weeks).The purpose of the study was improvement profilakticheskih activities based on identified pathogenetic mechanisms of occurrence of missed abortion. Aim of the study: to perfect the features of pregravid preparation for pregnant with undeveloping pregnancy in anamnesis on the basis of the educed nosotropic mechanisms of origin of this pathology, her intercommunication with a folats deficit. Materials and methods. Research was conducted in a few stages. On the first stage retrospectively on the basis of analysis 90 hospital charts are educed the supposed risk factors. On the second stage the exposure of reliable risk and development of algorithms of prognostication of undeveloping pregnancy (factors was conducted in 2 groups - basic (90 pregnant with stopping beating pregnancy) and control (30 pregnant with normally aleak pregnancy). The methods of prophylaxis of this pathology offered in high-risk of origin of stopping beating pregnancy groups. One of them was application of folates, namely vitamin-mineral complex before and after conception. Results. On the basis of undertaken studies multifactor genesis of missed miscarriage was confirmed, and the basic etiologic factors of origin of this pathology are educed. Stopping beating of pregnancy at anomalous karyotype takes place for certain before (6.2±0.8 weeks) what at normal karyotype (8.7±1.2 weeks). Cross-correlation connection was set between frequency of development of chromosomal anomalies and level of homocysteine from МТНFR677ТТ, level correlation of Spirmena equaled 0.84 - direct cross-correlation connection. As a result of undertaken a study one of methods of preparation application of folates offered in a kind vitamin-mineral complex for 16 weeks to conception and 12 weeks after conception. Conclusion. High-frequency of МТНFR677ТТ of heterogeneous or homozygous carriers educed for women with undeveloping pregnancy. Application of folates is in a vitamin-mineral complex, can be one of the most effective methods in the prophylaxis of early reproductive losses.

The individual choice of prolonged contraception, and qualified consultation reduce possible risks in its application (these literatures and own experience).