CRITERIA FOR CHOOSING THE OPTIMAL DELIVERY STRATEGY FOR PATIENTS WITH NERVOUS SYSTEM PATHOLOGY

48 birth histories of patients in the Perinatal center of the V. D. Seredavin SOKB with various diseases of the nervous system were analyzed. 27 patients had planned delivery by caesarean section, due to the combination of relative indications from the fetus and a burdened obstetric history, and 21 – delivery through the natural birth canal. Delivery via the natural birth canal was performed in women with epilepsy-in 28% of patients with neurocirculatory dystonia: - in 16%, with encephalopathy-in 12%, with a herniated disc: - in 12%, with a history of traumatic brain injury-in 12%, with dorsopathy-in 12%, with multiple sclerosis-in 8%, with lumboishalgia-in 4%, with multifocal glioblastoma – 4%. 48% of newborns in women after delivery through the natural birth canal were completely healthy, only 11% had signs of cerebral ischemia, and 19% had slightly pronounced hypoxic and hypotrophic changes. Joint observation of such women during pregnancy by an obstetrician-gynecologist and a neurologist with rational pre-test training allowed to avoid operative delivery.

CLINICAL CASE OF SUCCESSFUL MANAGEMENT OF PREGNANCY AND CHILDBIRTH IN A PATIENT WITH PERIPHERAL NERVOUS SYSTEM PATHOLOGY

The purpose of our study was to study the case of successful management of pregnancy and childbirth in patient K., 39 years old with pathology of the peripheral nervous system: spinal stenosis L5 – S1, herniated L5-S1, surgery in 2014 (hemilaminectomy L5-S1, disc resection L5-S1), vertebrogenic pain syndrome. At the stage of pre-test preparation and during pregnancy, she is consulted by a neurologist to determine the tactics of pregnancy and childbirth management. Rational pregnancy planning, joint management of a pregnant woman by an obstetrician-gynecologist and a neurologist allowed choosing the optimal pregnancy management tactics and delivery method.

THE PROBLEM OF OSTEOPOROSIS IN MENOPAUSAL WOMEN AND POSSIBLE SOLUTIONS

41 women with osteoporosis were examined. The age of the examined people ranged from 50 to 60 years. All the women were postmenopausal. As a result of the study, it was found that the most effective management strategy for such patients is a combination of menopausal hormone therapy and non-hormonal drugs that affect calcium metabolism in bone tissue, improve its metabolism and reduce resorption. If there are contraindications to MGT, prevention and treatment of osteoporosis should also be carried out using the appointment of non-hormonal drugs. In this case, the use of ipriflavone is effective.

THE ROLE OF HYSTEROSALPINGOGRAPHY IN DETECTING ENDOMETRIOSIS OF THE FALLOPIAN TUBES

This clinical example confirms the need for a thorough assessment of anamnestic data at the stage of pre-gravidar preparation, the need to analyze various possible causes of infertility and ectopic pregnancy, and the interpretation of data obtained by hysterosalpingography (HSG) in a patient without pronounced clinical manifestations of endometriosis, in the presence of ethologically proven risk factors for the development of this pathology, even in the absence of complaints. This method of research is informative in identifying the pathology of the reproductive system, including the fallopian tubes.

DIAGNOSTIC CRITERIA EARLY DIAGNOSIS ENDOMETRIOSIS

The purpose of this study is to study a clinical case of late diagnosis of endometriosis of the uterine body (adenomyosis), despite the presence of such typical clinical manifestations as heavy uterine bleeding, leading to the formation of chronic post – hemorrhagic iron deficiency anemia and the development of sideropenic syndrome, accompanied by weakness, dizziness, rapid fatigue, brittle hair and nails. Also, the data of the family history (endometriosis in the mother) and the patient's history indicating the presence of pollinosis and bronchial asthma were not taken into account.

FEATURES OF MANAGEMENT OF PITUITARY MICROPROLACTINOMA IN COMBINATION WITH ADENOMYOSIS

The purpose of this study was to study a clinical case of hyperpolactinemia caused by pituitary adenoma (microprolactinoma) and subsequent formation of adenimiosis – endometriosis of the uterine body in a patient. This clinical example illustrates the common ethological and pathogenetic mechanisms of formation of microprolactinoma and adenomyosis and justifies the need to choose the optimal management tactics for the patient taking into account these features (cabergoline 0.5 mg with dose titration and control of prolactin levels in dynamics in combination with dienogest 2 mg).

ENDOMETRIAL STATUS IN PATIENTS WITH OVARIAN ENDOMETRIOSIS AND FAILURES IN THE IMPLEMENTATION OF CHILDBEARING FUNCTION

The aim of the study was to study the state of the endometrium in patients with ovarian endometriosis and failures in the implementation of childbearing function. A retrospective analysis of IVF protocols was carried out, as well as a prospective examination of the immunological parameters and ultrasound characteristics of the endometrium, an immunohistochemical assessment of the endometrium in 55 women with laparoscopically confirmed ovarian endometriosis and 25 women with infertility due to the male factor, who were the control group. Significant differences were found in the immunohistochemical and immunological parameters of the endometrium in patients with ovarian endometriosis and IVF failures. A comprehensive approach to the assessment of endometrial function in patients is proposed, which can be used in patients at the stage of preparation for treatment with art methods in order to improve treatment outcomes for pregnancy.

OVERACTIVE BLADDER IN CHILDREN: CLINICAL AND PARACLINAL FEATURES

Research objective. To identify clinico-laboratorial and urodynamic deviations among children with overactive bladder. Materials and methods. The study is based on examination of 20 somatically healthy children of 7-10 years old with the following complaints: sudden irresistible urges to urinate, that could be hardly restrained with or without imperative urge incontinence; frequent urination in small portions during the day; frequent awakenings during the night due to the emerging urge to urinate and involuntary urination at night. All children have been examined clinically (identification of the level of homocysteine, registration of the rhythm of urination (by keeping a diary of urination)) and through instrumental methods: uroflowmetry, ultrasound examination of the bladder with identification of the volume of residual urine, electroencephalography. Results. After the examination, the following abnormalities were identified among the majority of the patients: hyperhomocysteinemia; registration of the rhythm of urination showed that the predominant type was pollakiuria, which might be observed in frequent (more than 8 times a day) urination in small portions (among 60% of children), also enuresis (among 65%) and daytime urinary incontinence in the one third of the patients (30%) were diagnosed. On the basis of ultrasound examination of the bladder, it could be concluded that the one third of the children (33%) had an increase in the volume of residual urine (due to a decrease in the contractile function of the detrusor). By the uroflow method of research it was found out that among almost the half of the children (45%), the intermittent type of urination prevailed (in which the maximum and average urine flow rate was reduced, the time to reach the maximum speed was shortened), also rapid (30%) and non-obstructive (25%) types were diagnosed. According to the electroencephalography data, disorganization of the alpha rhythm, with a tendency to an increase in the number of beta rhythm waves was found.

RATIONALE THE EFFECTIVENESS OF TREATMENT OF COMBINED PATHOLOGY OF REPRODUCTIVE SYSTEM CAUSED BY HORMONAL IMBALANCE AND IMMUNE SYSTEM

Based on the study of this clinical case, it is possible to evaluate the effectiveness of using dienogest for the treatment of combined pathology – polycystic ovary syndrome (PCOS) and endometriosis of the uterine body - adenomyosis. Given the common pathogenetic links in the formation of these diseases, the presence of an imbalance of the hormonal and immune systems in these diseases, the pharmacological properties of diengogest, its metabolic neutrality and the possibility of long-term use, the proposed management tactics should be considered effective for the treatment of this combined pathology.