Methods of intrauterine diagnosis of the fetus are far from perfect. The most promising assessment method based on a computerized analysis of the heart rhythm of the severity of hypoxic effects on the central nervous system of the fetus is the analysis of the characteristics of its heart rhythm. Modern fetal technologies validated using the Dawis-Redman criteria make it possible to diagnose fetal hypoxia with high sensitivity and specificity, which provides the basis for making tactical decisions. The remaining methods of analysis of cardiotograms are only screening, aimed at identifying risk groups for this pathology.

This article discusses the possibility of determining the severity of preeclampsia using platelet indicators. 69 birth histories were analyzed to determine the prognostic value of the characteristics of the circulating platelet pool during pregnancy complicated by preeclampsia. A study was conducted to identify differences in platelet indicators in pregnant women with a physiologically occurring pregnancy and pregnant women with severe preeclampsia. It was revealed that during pregnancy complicated by severe early preeclampsia, there is a change in platelet indicators - an increase in the proportion of young forms of platelets. It was found that the indicator of the fraction of immature platelets can serve as an additional criterion for determining the severity of preeclampsia.

Objective: To analyze the effectiveness of preeclampsia drug prevention using aspirin in pregnant women of risk group. Materials and methods: A comparative longitudinal prospective study of 854 pregnant women at risk was conducted. The main group consisted of 687 high- and medium-risk patients who received aspirin 75 mg per day from 12 weeks of pregnancy to delivery. The comparison group consisted of 167 high-and medium-risk pregnant women who did not receive aspirin. Results: The incidence of hypertensive disorders in women of the main group was 1.4 times (p<0.05), preeclampsia - 1.8 times (p<0.01), severe preeclampsia - 3.2 times (p<0.001) less than in patients of the comparison group.

The aim of study was to determine the frequency and structure of cervical pathology and its relationship with the vaginal microbiota in 113 pregnant women in period from 22 to 36 weeks. Microscopy of vaginal smears, cytological examination of the cervical epithelium, determination of the microbial mass of vaginal secretion using test system "Femoflor-17" and detection of human papillomavirus DNA (HPV) in real time was conducted. Statistical processing was performed with calculation of median, mean, standard deviation, confidence interval and Pearson correlation. HPV type 16 was found in 23.8%+4.2% (95% CI: 16.8-30.8%), other high-oncogenic types of HPV in 39.8%+5% (95% CI: 30.8-48.8%) of patients, while HPV type 18 was absent in all examined women. In 48 (55%) women the titer of microbial flora exceeded 104. Atopobium vaginae was detected in 43.7%+3.2% (95% CI: 39.7-47.7%) of pregnant women. According to the results of сytology, the inflammatory was found 27: 56,2%%+2,3% (95% DI: 51.9-60.4%) of pregnant women. Inclusion cytological smears type ASCUS was in 11: 9,7%+2,9% (95% CI: 4.7-14.7%) of women, which correlated with the detection of a combination of anaerobic and aerobic flora (r=0.76).

The evaluating of the results of rehabilitation measures after destructive treatment in patients with cervical leukoplakia associated with papillomavirus infection has been analyzed. It has been established that the use of the antibacterial drug Elzhina at the stage of rehabilitation is necessary to prevent secondary bacterial infection and improve regenerative processes, and the use of the vaginal gel Biofam, which includes lactic acid, glycogen and thyme oil, provides a combined advantage in colonization of the vagina with a lactobacilli flora and restores the pH level, which prevents the further reproduction of opportunistic pathogenic microflora and contributes to a reliable the timing of epithelization, the reduction in the number of relapses.

Ovarian reserve - the functional state of the reproductive system, the full value of which provides growth, maturation of the follicle, maturation of the oocyte in the dominant follicle, ovulation and fertilization of a full egg. A full ovarian reserve in assisted reproductive technology (art) programs provides an adequate ovarian response to the introduction of ovulation inducers and determines the success of such programs [4,5] Today, there are several ways to determine the biological and functional age of the ovaries. These methods help to predict the outcomes of infertility treatment by the method of assisted reproductive technologies (art). The development of a predictive model of fertility recovery in women with infertility due to premature depletion of ovarian reserve, based on the study of their molecular genetic and hormonal characteristics will improve the effectiveness of assisted reproductive technology programs.

Introduction / According to the literature of domestic and foreign authors in obstetric practice from all anomalies of labor, the primary weakness of labor remains one of the leading causes of perinatal morbidity and mortality. Purpose: determination of the possibility of personalized prediction of primary weakness of patrimonial activity and its severity based on the study of clinical, mitochondrial, molecular genetic factors to improve the outcome of urgent labor. Material and methods. Clinical and laboratory indicators of 287 pregnant women in the term of a gestation 39 weeks and 4 days - 40 weeks are investigated. Research SDG, α-GFDG carried out by a cytochemical method to R.P. Nartsissov's modifications (1969). The miometriya and placentae conducted an electronic and microscopic research in an electronic microscope of "Morgagni 268-D" at working increase from 2200 to 22000. The molecular and genetic research PPARA, PPARD, PPARG, PPARGC 1A, PPARGC 1B and AMPD was conducted by a pirosekvinirovaniye method with use of system of the genetic analysis of the PyroMark Q24 series. Results of a research. As a result of the work, two models for predicting the primary weakness of labor and severity ware proposed on the basis of a complex of clinical, biophysical, biochemical, molecular genetic, functional research methods to improve the outcome of timely delivery in young primiparous women. Conclusion. A new personalized model for predicting the primary weakness of labor activity provides a scientific, legal and clinical basis for the formation of a reasonable program for the completion of pregnancy.

The article discusses modern views on the possible role of various genetic networks in the pathogenesis of “Great obstetric syndromes”. The genes of thrombophilia, folate cycle, detoxification system, renin-angiotensin-aldosterone system, immunological response, energy metabolism and endothelial dysfunction are considered. The phenotypic implementation of genetic polymorphisms is discussed.

The article presents a comparative analysis of methods used for the diagnosis of genetic pathology in fetuses with malformations and / or developmental abnormalities. The standard cytogenetic analysis of the karyotype is most widely implemented and used, however, the low resolution of this method in 8Mb does not allow for the detection of microdeletions and microduplications, which in turn in 5-6% of cases are the causes of malformations and / or developmental abnormalities in the fetus. When using chromosomal microarray analysis (CMA) it increases the diagnostic efficacy of prenatal diagnosis, which allows making a diagnosis in a timely manner, determining the prognosis for the life of the child after birth. The choice of method for diagnosing genetic pathology in fetuses with congenital malformations and / or developmental abnormalities is currently not regulated and is often based on the technical capabilities of the laboratory. At the moment, a large amount of data has been accumulated confirming the effectiveness of the use of SNP microarrays compared to classical cytogenetic methods.

The development of modern biology and medical genetics raises the question of the philosophical interpretation of the results of testing for genetic susceptibility. The medical and legal implications of the information obtained and its use in clinical practice have not been fully studied, normative legal acts regulating the examination process for genetic markers of diseases are not perfect. At the same time, genetic testing is the most promising area of modern medical science and health care. The article sets out the views of the author on these problems.

Toxoplasmosis is a widespread opportunistic parasitosis. The frequency of Toxoplasma invasion in women with a history of complications is 54.8 ± 2.8%, and in women with normal pregnancies - 27.3 ± 3.6%. Clinically manifest form of chronic acquired toxoplasmosis was detected by immuno-statistical method in 24 women. The most frequent symptoms of intoxication in these women were weakness, fatigue, headaches, and pain in muscles and joints. In one third of women with chronic acquired toxoplasmosis, there was an increase in the lymph nodes, usually the occipital, cervical, submandibular. Of the gynecological pathology, the most frequently examined women had an inflammation of the uterus appendages (45.8%), and a spontaneous miscarriage was often noted in history. The immunogram of patients with chronic acquired toxoplasmosis was characterized by a decrease in absolute and relative number of T-lymphocytes - CD3 (541.3 ± 42.4 and 32.2 ± 9.9%), an increase in the number of NK-cells.

Objective: to determine changes in clinical and immunological parameters in patients with uterine leiomyoma, depending on the reproductive age. Study design: cohort prospective comparative study. Materials and methods. Investigation and surgical treatment of 220 patients of reproductive age was conducted. The main group consisted of 190 women aged 18-45 years, including 110 patients of early age (18-35 years) and 80 women of late reproductive age (36-45 years). Criteria for inclusion in the main group were uterine leiomyoma and the woman's reproductive age. The control group included 30 healthy women aged 18-45 years with normal reproductive function and no gynecological diseases. Results. Immunological parameters of peripheral blood of women with uterine leiomyoma were characterized by a statistically significant increase in comparison with the control group. The maximum and reliable values of the growth in the number of lymphocytes, the absolute content of CD3 +, CD8 +, CD19 + and CD16 + / 56 + lymphocytes, the NST test, complementary activity and circulating immune complexes of serum were determined in women of early reproductive age (p<0,05-0,001). Quantitative values of these parameters in patients of late age had an "intermediate" character and significantly lower values than at an early age, but did not reach the level of the control group. inclusion. Leiomyoma in reproductive age was accompanied by intensity of cellular and humoral immunity. The immune response in patients with uterine leiomyoma was differentiated depending on the period of reproductive age and was more pronounced in patients 18-35 years of age.

The article presents the issues of epidemiology, pathogenesis and diagnosis of abnormal carbohydrate and lipid metabolism during pregnancy. The main risk factors for gestational diabetes mellitus (GDM) are demonstrated. Despite the existing methods of antenatal and delivery care, in recent years there has been an unfavorable tendency to increase the frequency of gestational diabetes. The choice of a rational research algorithm in the early stages of gestation can improve perinatal outcomes.

The purpose of this research is to analyze the demographic situation in Perm region with the assessment of obstetric indicators. The information is obtained from the official data of the Department of Population and Health Statistics of the Territorial Agency of the Federal State Service of State Statistics of Perm Region (PERMSTAT) for 1990-2017. The dynamics of population, fertility and mortality, natural increase (decrease), gender and age structure of the population were objects of this study. Results: Perm region birth rate is characterized as low, and with a tendency to estimate it is very low (approaching 10 percentile). From 2006, the number of observables during pregnancy increased until 2015 in the city of Perm and until 2012 in Perm Region. Since 2012, there has been a decrease in patients registered for pregnancy (by 9.2% of Perm in 2016 and by 22% in Perm Region for 2017). Within 10 years, there is a tendency to increase the load on the examination and treatment of pregnant women on an outpatient basis, in connection with which there has been a reduction of stationary obstetric beds in 2012 with PC by 32.2%. The age and sex structure of the regional population belongs to a pronounced regressive type. Conclusion: In the features of the current demographic situation, the most attention should be given to measures aimed at preserving and increasing the reproductive potential of the Russian Federation.

In recent years, the influence of genital infection on pregnancy and perinatal outcomes has been actively studied. The question arises-why genital infection during pregnancy in some cases can cause premature birth, and in others practically does not affect its course is not fully understood. Objective: to assess the features of history, pregnancy, structure of infectious pathology and its treatment in women with timely and premature birth. 112 women with infectious diseases of the vagina and cervix were retrospectively analyzed. It was found that the structure of infectious pathology of the lower reproductive tract in women with spontaneous preterm labor was represented by: cervicitis-29.4%, vaginitis-21.6%, their combination (cervicovaginitis) - 17.6%, bacterial vaginosis - 15.7%, vaginal dysbiocenosis - 15.7%. In very early and early preterm labor, the most common form of infectious pathology of the lower genitals was cervicovaginitis; in preterm labor - vaginitis. Structure of genital infections in patients with the timely childbirth: cervicitis is 27.9%, vaginitis - 26,2%, desbiens vagina - 16,4%, bacterial vaginosis -14.8%, cervicovaginitis is 14.8%. Conclusions: there were no differences in the structure of infectious pathology of the lower reproductive tract in women with spontaneous premature and timely delivery. In patients with genital infection, pregnancy in which ended spontaneous preterm birth significantly more often than in the comparison group there were: burdened obstetric and gynecological history, diseases of the urinary system, persistent threat of termination of pregnancy, placental insufficiency, iron deficiency anemia. In patients with spontaneous premature birth percentage of morphologically confirmed intrauterine infection was significantly higher than in women who gave birth at term and the set of morphological forms were distinguished by a higher degree of involvement of the tissues of the placenta in the inflammatory process (membranes, placenta).

To study the influence of laser irradiation on clinical and biochemical blood indices, we conducted a study of 60 women with peritonitis after cesarean section. Women were divided into 2 groups of 30 women. All postpartum women first (primary) and second group (control) was carried out antibacterial and infusion therapy integrated. Further laser irradiation of the inguinal lymph got all the puerperas of the control group. As a result of our study it is established that a laser irradiation in puerperas after cesarean section contribute to a substantial improvement of rheological properties of blood, reduces toxicity, normalization of erythrocyte sedimentation rate, leukocytosis, reduction of blood coagulation.

In order to provide psychological assistance to the puerperal in case of intrapartum fetal death, various measures have been taken: informational assistance, psychological support, spiritual assistance, psychological counseling, psychotherapy, and drug therapy. An assessment of the psychological state of a woman is given. The stages of rendering psychological assistance to the puerperal in the obstetric institution and after discharge from it are presented.

The state of health of students is one of the important components of the well-being of society. One of the most important components of student health is its dental aspect. The purpose of the study was to study the organizational aspects of dental care for students and the development of scientifically based proposals for its improvement. The study was conducted in 20172018. on the basis of the Department of Orthopedic Dentistry, DGMU and in dental clinics. The object of the study were boys and girls aged 17-25 years, only 327 people. The study showed that among students, 73.4% positively relate to an appearance in private dentistry, 15% - negatively, 12% - were undecided about this. For students is the most important when visiting the dental organization, are: the quality of medical care - 52%; the ability to quickly get help at a convenient time - 31%; convenient territorial location, close to the place of study - 24%; free or affordable price - 10%; friendly, attentive staff - 9%; aesthetics of the interior, staff and the corresponding service - 7%. 75% of students stated that high quality dental services are available only in the private sector. These data indicate that the quality of therapeutic and orthopedic care in commercial dental organizations is objectively at a higher level. Public dental clinics are inferior to commercial, both in quality of materials and in the quality of work performed.

The article describes the incidence of nasal and paranasal sinus in the Khanty-Mansi Autonomous District,outlines proposals for optimizing treatment to reduce the incidence and expectation of patients requiring routine surgical treatment. Introduced hospital replacing minimally invasive technologies in outpatient settings (endoscopic using of the shaver system, radiosurgical methods), simultaneous operations were introduced. Use of a substitution therapy hospital allowed to reduce waiting times for a planned operation with nasal and paranasal sinusitis for 6 months (from 8 months to 2 weeks), due to an increase in the number of operations 5 times, given the climatic conditions of the North of Western Siberia

In research we investigated the effectiveness of therapy associated with transient corneal conjunctival xerosis: the patients after surgery a Lasik, includes traditional complex therapy with antibiotic, steroid anti-inflammatory and agents for substitution therapy and combinative therapy with immunomodlators and antioxidant agents. The comparative analysis of clinical symptoms, results of visiometry, data of laboratory examination, indicators of production of lacrimal liquid, factor of local immune protection at application of the medicines containing immunomodulators and antioxidants in the form of eye drops in the complex scheme of therapy of corneal-conjunctival xerosis was made. Pharmaceutical interaction was excluded by observing time intervals. The proposed scheme increased the secretion of lacrimal fluid and the factor of local immune protection of the epithelium of the mucous eye of patients. In this case, there was a decrease in clinical symptoms of the disease, a decrease in the sensitivity of the cornea to external factors, a positive dynamics of laboratory parameters, a decrease in the side effects of steroid anti-inflammatory drugs and antibacterial agents, which are expressed in increasing local immunity and improving the quality of life of patients.

A comparative study of the efficacy and safety of therapy of transient corneal-conjunctival xerosis (ССХ) was conducted. Patients suffering from ССХ received topically in the form of eye drops immunomodulators and antioxidants accompanied by traditional therapy, including a glucocorticosteroid, an aminoglycoside group antibiotic and substitution therapy with a preparation containing dextran-70 and hypromelase. The chemical interaction between the components of the schemes was excluded, since the time intervals for instillation of the drugs were respected. Based on the dynamics of laboratory data, instrumental examination (results of visiometry) and clinical manifestations of ССХ, conclusions were drawn about the rationality and safety of the therapy used. Analysis of the production of tear fluid, the stability of the tear film, the results of optical coherence tomography (OCT) revealed the clinical and pharmacological advantage of the scheme containing the immunomodulator and antioxidant.

Objective: to reveal the role of anatomical variants of coronary dominance in the localization of the infarct-dependent artery, the focus of necrosis and their interrelations. Materials and methods: The coronary angiography of 133 patients was retrospectively analyzed. Two groups were compared: patients with acute myocardial infarction and unstable angina. According to the coronary dominance of the heart, patients were divided into 3 subgroups: left-dominance (LD), right-dominance (RD) and balanced type. Results: patients with LD and myocardial infarction commonly occurred with significant stenosis of the left anterior descending artery (LAD), mainly in the proximal part. The right coronary artery (RCA) and the posterior lateral branch were infarction-dependent arteries for patients with RD. At the low localization of the focus of necrosis, the LAD is the infarct-dependent in patients with LD and RD of coronary dominance. However, the focus of necrosis of the anterior localization among patients with LD was significantly more common in LAD stenosis in the proximal and middle segments. Among patients with RD, significant stenosis of LAD in the proximal segment and the first obtuse marginal artery (OM1) were significant causes of myocardial infarction with the focus of necrosis in the anterior localization. Lateral myocardial infarction with LD was associated with significant stenosis of the first diagonal artery (D1). Whereas RD - with OM1 and LAD in the proximal segment. Stenosis of the right coronary artery often leads to the posterior MI. Posterior myocardial infarction wasn't identified among patients with LD type. Conclusion: we found differences in the arteries, the hemodynamically significant stenosis of which is reliably associated with the development of anterior, lateral and posterior myocardial infarction. These findings may indicate that among patients with different artery dominance there're differences in the blood supply of the anterior and lateral walls of the left ventricle (and not only of the posterior wall).

This article is devoted to the analysis of the effectiveness of rehabilitation of patients with bronchial asthma in combination with arterial hypertension in a sanatorium Yangan-Tau. To perform the work were examined in 62 people aged 27 to 65 years. All patients were performed a questionnaire, ERF test with a 6-minute walk test, electrocardiography, Stange's functional test, and the quality of life dynamics was determined using the official Russian-language counterpart of the SGRQ questionnaire -"Questionnaire for patients with respiratory diseases of St. George's Hospital." The results of the study showed a statistically significant increase in volumetric and flow rates, an increase in the distance of the test with 6-minute walking, improvement of the quality of life according to the SGRQ questionnaire on the background of rehabilitation.

In recent years, there has been a steady increase in chronic diffuse liver diseases, which are characterized by severe, progressive and are one of the main causes of disability and mortality in developed countries. The course and prognosis of chronic hepatitis and liver cirrhosis are largely determined by the state of the immune status of the organism. At all stages of the immune response, cytokines take an active part in it, which regulate intercellular and intersystem interactions. The literature review presents current data on the role of cytokines in the development of CDLD and portal hypertension.

The study was undertaken to assess the diagnostic and therapeutic possibilities of video laparoscopy and the reasons for the failure of laparoscopic interventions in patients with acute adhesive intestinal obstruction in a city multi-field hospital. A retrospective analysis of laparoscopic interventions in 110 patients is presented. In 14 (12.7%) cases, the study allowed to exclude competing diagnoses and understand the true cause of the disease. In 19 (17.3%) cases, an attempt at laparoscopic diagnosis was unsuccessful. In 28 (25.5%) cases, laparoscopic attempts to eliminate obstruction were ineffective. In 20 (18%) cases after laparoscopic evaluation, a laparotomic method of treatment was immediately selected without attempting laparoscopic adhesiolysis. Laparoscopically, the adhesions that caused the disease were eliminated in 29 (26.4%) cases. At the same time, there is a potential possibility of increasing this indicator by up to 50% with timely laparoscopic intervention (before the development of excessive dilatation of the intestine). In cases where laparoscopic surgery was successful, they had all the advantages of minimally invasive interventions.

The relevance of a research of clinical manifestations and techniques of treatment and prevention of osteochondrosis when planning pregnancy is extremely high, in connection with influence on the patient, the course of pregnancy and the further result of childbirth. The physiology and pathology of bodies of the reproductive sphere, feature of a course of pregnancy and childbirth at women with dorsopatiya are insufficiently studied. Publications of the Russian and foreign authors showed that about 60% of pregnant women feel back pains on different terms of pregnancy. As during pregnancy in a female body there are various changes which can lead to complications during incubation of the child. Especially to physiological and specific changes the bone and articulate system softening not only joints, but also skeleton ligaments is subject. Articulate sheaves in lumbar department of a backbone are also exposed to influence of hormones, and in a complex with increase in weight and need of a deviation of a body can cause back pain back. Among the manifestations of vertebrogenny pathology bringing to pregnant women the greatest sufferings the pain syndrome which amplifies in process of increase in terms of a gestation is on the first place. In article complexes of physiotherapy exercises when planning pregnancy are described.

The aim of the study is determined the phenotypes and the features of clinical manifestations of conscripts with undifferentiated connective tissue dysplasia (CTD). Materials and methods. Examined 118 men 18-25 years, conscripts, who had no acute diseases. External signs of CTD were determined and CTD phenotypes were diagnosed on the basis of modern Russian recommendations. The study group consist of men with 6 or more external signs, the control group consist of men with less than 6 signs. Evaluated the Hospital anxiety and depression scale (HADS), visual analogue scale (VAS) of pain, scale of asthenic condition, Vein Questionnaire of autonomic dysfunction. Results. Among the 118 surveyed 6 or more of CTD were detected in 74 (62.7%). Was following phenotypes: unclassified - 22 (29,7%), marfanoid appearance - 10 (13,5%), the joint hypermobility syndrome - 8 (10,8%), the combination of marfanoid appearance and joint hypermobility syndrome -7 (9,5%), increased external stigma - 7 (9,5%), increased visceral stigma - 6 (8,1%) and others. The CTD group (n=74) did not differ from the control group by age and sex, but had higher growth and hand span and lower body mass index values. found There are higher scores of HADS anxiety scale, fatigue and scores on Vein Questionnaire in the CTD group. Subjects with CTD showed more pronounced pain in the joints, back and heart. Conscripts with CTD tended to extend the QT interval on ECG (p=0.079) and lower end diastolic volume. Conclusion. CTD was diagnosed in 62.7 % of the conscripts (n=118). The most frequently recorded the unclassified phenotype, marfanoid appearance and joint hypermobility syndrome. Men with CTD had lower BMI values, more severe performance anxiety, asthenia, autonomic disorders, joints pain, back pain and heart pain and lower end-diastolic volume.

The results of the study of the etiological structure and antibiotic resistance of the main pathogens of bacteremia and sepsis, isolated from patients in medical institutions of the city of Makhachkala are presented. Gram-positive microorganisms (67.42%) have been shown to have the largest specific gravity among the selected blood cultures, for the treatment of which vancomycin, rifampicin, linezolid, cefazolin, oxacillin are preferred, and for green streptococci benzylpenicillin is preferable. For the elimination of gram-negative pathogens, whose share was 30.71% of all positive findings, imipenem, amikacin, ceftazidime and ciprofloxacin were the most effective.