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Болезнь Крона относится к воспалительным заболеваниям кишечника неустановленной этиологии. Данная патология чаще поражает лиц молодого возраста, поэтому может встречаться при беременности и осложнять ее течение. Представлен случай кишечной непроходимости, обусловленной болезнью Крона, при беременности. Описаны клинические проявления, приведены данные дополнительных методов исследования, представлены результаты морфологического исследования, послужившие основой для верификации диагноза. Особый акцент сделан на тактике ведения пациентов с острой хирургической патологией при беременности. Приведен краткий обзор литературы по данной проблеме. В описанном случае причиной кишечной непроходимости стала болезнь Крона, впервые диагностированная только при беременности. Осложнения болезни Крона – показание для хирургической интервенции, не являются основанием для изменения акушерской тактики: в большинстве случаев беременность следует пролонгировать с использованием специфической терапии.

The purpose of the study – to study the hormonal background of the fetoplacental complex and the psycho-emotional state in pregnant women living in the region of military conflict. Material and methods. 85 pregnant women aged 27 to 32 were examined. The main group included 55 women examined in 2020-2023. The control group consisted of 30 healthy pregnant women examined in peacetime. The study of hormones of the fetoplacental complex and the psychoemotional state was conducted in the I, II, III trimesters of pregnancy and on the 3-4 day of the postpartum period. Results. In the first trimester of pregnancy in the main group 2 (3.6 %) patients were in a state of psychoemotional stability, 8 (14.5 %) pregnant women (p < 0.05) were in a state of psychoemotional tension (p < 0.05), 21 (38.2 %) patients (p < 0.05) were in a moderate degree, and 24 (43.6 %) women (p < 0.05). In the second trimester, respectively – 3 (5,5 %), 9 (16,3 %), 20 (36,4 %) and 23 (41.8 %) pregnant women (p < 0.05). In the third trimester, respectively – 3 (5,5 %), 13 (23,6 %,) 22 (40,0 %) and 17 (30.9 %) patients (p < 0.05). In the postpartum period 2 (3.6 %) maternity hospitals were in a state of psychoemotional stability, 17 (30.9 %) were in a state of mild psychoemotional stress, 23 (41.8 %) were in a moderate degree, 13 (23.6 %) were in a severe degree (p < 0.05). Against this background, pregnant women of the main group in the second trimester had an increase in the concentration of placental lactogen by almost 20.0 %, estradiol and cortisol by almost 50.0 % compared with the control parameters (p < 0.05). In the third trimester of pregnancy in the main group, placental lactogen decreased by 20.0 %, estradiol and cortisol by almost 50.0 % compared with the corresponding indicators in the control group (p < 0.05). Conclusion. The resulting psychoemotional stress of medium and high degree in pregnant women living in a military conflict zone has an adverse effect on the hormonal background of the fetoplacental complex and indicates both tension and a violation of the compensatory capabilities of the fetoplacental system. The research obtained indicates the need to develop and apply therapeutic and preventive measures with the inclusion of rational methods of psychocorrection for pregnant women and maternity patients living in a military conflict zone.

Creation of a situation center in the State Institution Tula Regional Perinatal Center named after V.S. Gumilevskaya was aimed at increasing the efficiency of the obstetrics and gynecology service in the region through the prism of modern technologies. The combination of modern technologies and medical knowledge in the situation center makes it a relevant tool for improving medical care for pregnant women and newborns, providing a medical institution with the opportunity to make and implement decisions based on advanced information technologies and data analytics. The introduction of a situational center into the work of the obstetrics and gynecology service made it possible to reduce the number of errors in routing pregnant women at the regional level.

Введение. Изучались особенности ферментов и трансаминаз в слюне и копрофильтрате в системе «Мать–плацента–плод» у женщин по триместрам беременности и в послеродовый период. Цель исследования — изучить ферментный профиль биологических жидкостей при беременности, установить связь между содержанием ферментов в крови, выделением их в составе экскретов и рекретов с активностью трансаминаз в соответствующих субстратах. Материалы и методы. Материал для исследования брался у небеременных и беременных женщин. Изучалась динамика изменения активности гидролаз в биологических жидкостях. Результаты. Показано участие рекреторного и экскреторного путей выделения ферментов из крови и организма при беременности, обособлено участие слюнных желез в рекреции гидролаз в ферментном гомеостазе. Выводы. В гомеостазировании гидролаз не исключено участие трансаминаз и щелочной фосфатазы, что доказывается ферментным профилем биожидкостей при беременности.

Большинство женщин во время беременности испытывают ряд проблем со здоровьем, например боли в спине, тревогу, нарушения сна, головные боли и т. д. При этом лечение данных состояний рекомендуется проводить с минимизацией фармакологического воздействия. Поэтому актуальными становятся немедикаментозные методы, такие как массаж и, в частности, виброакустический массаж поющими чашами. Однако существует мнение об осторожном применении массажа во время беременности, особенно в первый и последний триместры. Цель настоящей работы – анализ преимуществ массажа и специфики его применения у беременных, а также определение возможности использования авторского метода виброакустического массажа поющими чашами (патент RU 2687006 C1) в пренатальный период. В связи с этим проведен анализ публикаций о преимуществах массажа и особенностях его применения у беременных. Поиск научных работ осуществлялся в базах данных ScienceDirect, Cochrane Library, eLIBRARY, PubMed по ключевым словам: massage therapy, pregnant women, сlassical massage, pregnancy, massage, physical therapy modalities, relaxation, pregnancy massage, antenatal massage. В результате сделаны следующие выводы: 1) здоровые женщины с неосложненной беременностью могут получать массаж в течение всего пренатального периода; 2) массаж во время беременности уменьшает симптомы депрессии и тревоги, нарушения сна, ослабляет боль в ногах и спине и оказывает положительное влияние на иммунную функцию; 3) во время массажа для беременных следует применять умеренное давление; 4) женщинам с осложненной беременностью массаж следует проводить только после консультации с акушером; 5) виброакустический массаж поющими чашами улучшает кровообращение, снижает тревожность, улучшает эмоциональное состояние и качество сна, что делает данный метод перспективным при беременности, однако требуются дальнейшие исследования для определения его эффективности, безопасности и корректировки протокола процедуры с учетом особенностей его применения у беременных.

Recently, there has been a trend towards a significant increase in uterine tumors, in particular fibroids, in women of reproductive age. Manifestations of uterine fibroids during pregnancy depend on the location and size of the fibroids. Prevention before pregnancy consists of timely treatment of uterine fibroids using organ-preserving medical technologies at the stage of preconception preparation. With the onset of pregnancy, in such patients, the content of sex steroid hormones in the local bloodstream of the uterus changes, the volume of nodes increases due to cellular hyperplasia and hypertrophy, cellular hyperplasia in myomatous nodes is blocked, and the death of myocytes in the central zone of the nodes is accelerated. Up to 75 % of pregnant women with uterine fibroids undergo surgical treatment, including conservative myomectomy. In this category of pregnant women, the frequency of spontaneous abortions and premature births is higher. There have been cases of spontaneous uterine rupture during pregnancy after embolization of the uterine arteries.

Введение. Вопросы инкреции ферментов пищеварительных желез изучались с шестидесятых годов прошлого столетия и по настоящее время. Ферменты индуцируют функциональную активность секреторных желез и подготавливают пищеварительный тракт грудного ребенка к дефинитивному питанию через период смешанного питания. Цель исследования — изучить источники ферментного обеспечения гематрофного, амниотрофного и лактотрофного питания плода, происхождение ферментов амниотической жидкости, молозива и грудного молока и их участие в аутолизе нутриентов плода и новорожденного. Материалы и методы. Материал для исследования брался у небеременных и беременных женщин. Изучалась динамика изменения активности гидролаз в биологических жидкостях. Результаты. Показано участие инкретируемых в организме матери ферментов в трофосистемах при беременности и в постнатальный период. Выводы. Во время беременности выделяются три системы: гематрофная, амниотрофная и лактотрофная с аутолитическим пищеварением инкретируемыми нзимами.

The purpose of the work – studying the characteristics of reproductive motivation and emotional state of pregnant women. Materials and methods. 42 pregnant women aged 18 to 42 years were examined in the pregnancy pathology department of the Donetsk Clinical Territorial Medical Association. The following methods were used in the study: the Rokeach Terminal Values Scale, the «Attitude Test of Pregnant Women» technique; «Personal Anxiety Scale» (J. Taylor); questionnaire «Current state», method by I.V.»Dobryakova «Attitude Test of Pregnant Women» to determine the type of psychological component of a woman’s gestational dominance during pregnancy. Results. The highest value of the unborn child was recorded among women 26-30 years old (91.8 %) with a high level of education (85.7 %) from two-parent families. When analyzing the psycho-emotional state of pregnant women for the first time and those in the third trimester of pregnancy, it was revealed that the process of bearing a child is accompanied by increased anxiety for the unborn child and the upcoming birth with a predominance of the anxious type of gestational dominant was identified in 6 respondents (40 %), the optimal type in 2 (13,3 %), the predominance of the euphoric type in 4 (26.6 %) women, the hypogestognosic type was diagnosed in 2 (13.3 %) women. The severity of the depressive type was identified in 1 (6.7 %). Conclusion. When analyzing the psycho-emotional state of pregnant women for the first time and those in the third trimester of pregnancy, it was revealed that the process of bearing a child is accompanied by increased anxiety for the unborn child and the upcoming birth with a predominance of the anxious type of gestational dominant. The data obtained indicate that the psycho-emotional state of pregnant women who have not previously given birth requires more careful consideration and psycho-corrective measures

According to Rosstat, the birth rate in the Russian Federation for 2022 decreased by 8.6 % compared to the same indicators for 2021. The average age of a woman at the birth of a child is 28 years 10 months. At the same time, the share of women of late reproductive age in the age structure of fertility is growing. However, with increasing age of a woman, the influence of factors that increase the risks of adverse obstetric and perinatal outcomes increases. Women of late reproductive age have an older age of the first birth, more often resort to the use of assisted reproductive technologies, are at risk for preeclampsia, premature birth and require an individual approach to the management of pregnancy and childbirth.

A scar on the uterus occurs more often due to the delivery of women by CS surgery in the anamnesis (78-84 %). Maternal mortality is mainly associated with uterine rupture (22-75/10000), bleeding, thromboembolic and infectious complications. The frequency of endometritis in the postpartum period increases by 1 % (289/10000 compared to 180/10000 during elective cesarean section). With planned CS, the risk of thromboembolic complications increases 3.8 times, uterine rupture in subsequent pregnancies – 42 times, abdominal pain – 2 times, bladder injury – 36 times. This publication is devoted to the delivery of a woman with a complete rupture of the uterus along the scar after previous cesarean sections.

To date, the question of the impact of the COVID-19 virus on human health and life is still relevant. Of course, severe manifestations of this viral disease negatively affect a woman's reproductive health. Vaccination against the new COVID-19 coronavirus infection with the combined Gam-COVID-Vac vector vaccine does not have a negative effect on the course of pregnancy and does not affect the outcome of childbirth. On the contrary, the probability of complications and concomitant pathologies decreases. Thus, it can be said that vaccination is an important stage of pre-gravidar preparation.

Uterine fibroids are the most common benign tumor of the female reproductive system. The incidence of the disease among women of reproductive age reaches 70%. In most women, the disease is asymptomatic, which makes it difficult to assess the true prevalence. In some cases, uterine fibroids do not prevent the onset of pregnancy and fetal development, but increase the frequency of complications of pregnancy and childbirth. During pregnancy, an ultrasound examination should be performed to assess the condition of the fetus and pelvic organs. Indications, access and scope of surgical intervention are determined by commission (by decision of the medical council). This publication is devoted to the delivery of a woman with large uterine fibroids.

Ovarian Hyperstimulation syndrome (OHSS) is a rare disease that can lead to fatal complications, almost always associated with the induction of ovulation by gonadotropins or sometimes clomiphene citrate. However, OHSS also occurred in spontaneous ovulatory cycles and rarely in non-pregnant women. The etiology and pathogenesis of spontaneous OHSS are insufficiently studied. In almost all cases, the disease regresses spontaneously and is treated expectantly or conservatively, but with termination of pregnancy or surgical intervention in case of complications. This publication is devoted to the clinical observation of the development of spontaneous ovarian hyperstimulation syndrome.

A review of the scientific literature has been conducted, including randomized clinical studies on the state of health and pathology of the nervous system of newborns whose mothers suffered a new coronavirus infection during pregnancy. Publications of PubMed, ClinicalKey, MedLine, Google Scholar databases were analyzed. The article was selected if it reported data on newborns with neurological disorders associated with SARS-CoV-2 infection. The processes of fetal brain damage, due to SARS-CoV-2 infection in the mother, are triggered in utero. At the same time, there are not only functional disorders, but also structural damage to the substance (hyperechogenicity of the white matter and basal ganglia, a decrease in the amount of tissue myelin). The main cause of perinatal neurological disorders is pathological perfusion of the placenta due to altered coagulation, inflammatory changes or microangiopathic conditions, what causes hypoxic and ischemic brain damage to the fetus and newborn.

Известно, что дефицит массы тела сопряжен с повышенным риском развития осложнений беременности со стороны матери. Цель исследования. Выявить предикторы неблагоприятных событий во время беременности у женщин с дефицитом массы тела. Материал и методы. Обследованы 82 беременные женщины с дефицитом массы тела. Контрольную группу составили 35 беременных женщин с нормальной массой тела. Всем пациенткам, включенным в исследование, проводились общепринятые клинико-инструментальные и лабораторные обследования, включающие сбор анамнестических данных, физикальные обследования, комплекс лабораторных исследований, трансторакальную эхокардиографию, холтеровское мониторирование электрокардиограммы. Результаты. Выявлены предикторы риска развития осложнений беременности со стороны матери и их пороговые значения: ИМТ 1,765 ммоль/л, ЛПНП >2,79 ммоль/л, лептин 400 в сутки. Выводы. Беременность на фоне дефицита массы тела характеризуется такими осложнениями, как угрожающий выкидыш, токсикоз, ХФПН, патологическое количество околоплодных вод (многоводие, маловодие), преэклампсия, гестационная артериальная гипертензия, отслойка плаценты, гипертрофия плаценты. Разработана прогностическая модель для оценки риска развития осложнений во время беременности со стороны матери у беременных с дефицитом массы тела.

Эктопическая беременность представляет собой патологическое состояние, при котором имплантация оплодотворенной яйцеклетки происходит вне полости матки. Согласно статистическим данным, самая распространенная локализация эктопической беременности – маточные трубы (98-99% случаев), в то время как шейка матки – редко встречающееся место имплантации (0,1-0,4%). Вместе с тем, анализируя осложнения гестационного процесса, можно сказать, что именно шеечная беременность повышает риск возникновения кровотечения, приводя к необходимости экстренного оперативного вмешательства. В представленной статье приведен случай из практики, характеризующий тактику диагностики и лечения в случае подозрения на шеечную беременность. Анализ ведения данной беременности доказал необходимость дифференцированного подхода к каждому случаю эктопической беременности. Такой алгоритм способствует быстрой и точной постановке диагноза и разработке тактики ведения беременности при развитии кровотечения.

The review article is devoted to the issue of the need to identify thyroid diseases in pregnant women, especially in the territory of natural iodine deficiency. The role of natural iodine deficiency in terms of the impact on the incidence of iodine deficiency diseases, the relationship with complicated pregnancy and adverse perinatal outcomes is shown. The ways of solving the prevention of thyroid diseases and the complicated course of pregnancy by identifying a risk group and timely individual prevention of iodine deficiency are considered.

Актуальность. Подготовка к беременности пациенток с экстрагенитальной патологией – актуальная проблема современного акушерства. Цель. Сравнительная оценка течения и исходов беременности у пациенток с недифференцированной диcплазией соединительной ткани (НДСТ) при использовании общепринятой и персонализированной прегравидарной подготовки. Материал и методы. Обследованы 262 пациентки, из них с НДСТ – 159. Группа I (основная группа) – 125 пациенток с НДСТ, которым проводился общепринятый объем прегравидарной подготовки: фолиевая кислота – 400 мкг/сут, калия йодид – 200 мкг/сут внутрь в течение 3 месяцев. Группа II (группа вмешательства) – 34 пациентки, получившие персонализированную прегравидарную подготовку: фолиевая кислота – 400 мкг/сут, йодид калия – 200 мкг/сут внутрь в течение 3 месяцев, а также препараты Mg2+ в дозе 300 мг/сут, глицин – 400 мг/сут, мультивитаминный комплекс, содержащий: витамин В1 – 10 мг/сут, витамин В 2 – 10 мг/сут, витамин В6 – 10 мг/сут, витамин Е – 400 мг/сут внутрь в течение трех месяцев. Контрольную группу (группа III) составили 103 пациентки без признаков НДСТ, получавшие стандартный объем прегравидарной подготовки. Оценка эффективности персонализированной прегравидарной подготовки осуществлялась согласно критериям доказательной медицины рассчитывались: относительный риск (RR); снижение относительного риска (RRR); снижение абсолютного риска (ARR); число пациентов, которых надо лечить, чтобы предотвратить 1 неблагоприятный исход (NNT); отношение шансов для определенного исхода (OR). Результаты. В группе вмешательства получены статистически значимые результаты по снижению риска развития угрозы прерывания беременности и преждевременных родов у пациенток с недифференцированной дисплазией соединительной ткани, снижению абсолютного риска развития истмико-цервикальной недостаточности. Выводы. Выявление признаков НДСТ на прегравидарном этапе, использование персонализированной прегравидарной подготовки у данной группы пациенток способствует улучшению перинатальных исходов.

Введение. Неожиданное появление и быстрое распространение по всему миру новой коронавирусной инфекции COVID-19 с большим количеством смертельных исходов показало значимость разработок способов прогнозирования тяжелого течения вирусных инфекций, создания диагностических тестов, профилактических вакцин и лекарственных препаратов, действующих на ключевые факторы течения и прогрессирования заболевания. Клинические исследования по изучению метаболомных изменений у беременных с инфекцией COVID-19 практически отсутствуют. Цель исследования. Изучить особенности метаболического профиля свободных аминокислот при беременности, осложненной COVID-19. Материал и методы. Исследованы концентрации свободных аминокислот и их производных в плазме крови 86 женщин. Основная группа – 51 беременная с подтвержденным диагнозом COVID-19; контрольная группа – 35 соматически здоровых женщин с беременностью без осложнений. Анализ аминокислот и их производных был осуществлен с помощью высокоэффективной жидкостной хроматографии. Результаты. При развитии инфекции COVID-19 преобладает катаболизм белков, что подтверждается повышением концентрации 28 аминокислот и их производных в плазме венозной крови. У беременных с новой коронавирусной инфекцией выявлено статистически значимое повышение концентрации цистеина, гомоцистеина, γ-глутамилцистеина, фосфосерина, цистеинсульфината, аспартата, гомоцистеата, глутамата, аспарагина, серина, треонина, 1-метилгистидина, глицина, цитруллина, аргинина, аланина, симметричного диметиларгинина, асимметричного диметиларгинина, β-аминомасляной кислоты, γ-аминомасляной кислоты, тирозина, валина, метионина, фенилаланина, лейцина, изолейцина, лизина, орнитина по сравнению с пациентами контрольной группы. Выводы. Изучение особенностей метаболического профиля свободных аминокислот у беременных с новой коронавирусной инфекцией позволит выявить дополнительные биомаркеры тяжести заболевания, прогнозировать течение заболевания у пациенток в период гестации.

Цель исследования. Определить значение недифференцированной дисплазии соединительной ткани (НДСТ) как фактора риска осложнений беременности и родов. Материал и методы. Проведено проспективное, когортное, рандомизированное, контролируемое исследование. С учетом критериев включения и невключения в исследование вошли 228 женщин в возрасте 18-42 года. Сформированы 2 группы. Основную группу составили 125 пациентов с малыми аномалиями развития сердца и не менее 4 признаков НДСТ. Группу сравнения составили 103 беременных без признаков НДСТ. Изучены особенности менструального цикла, течение беременности и родов и перинатальные исходы. Результаты. Установлена роль НДСТ как фактора риска в развитии осложнений беременности и родов: наличие НДСТ повышает вероятность развития угрозы прерывания беременности в I триместре в 2,7 раза, во II и III триместрах – в 3,4 и 3,9 раза, соответственно. Среди беременных с проявлениями НДСТ вероятность развития плацентарных нарушений была на 227% (ДИ 172,6-281,4) выше, чем в контрольной группе. Выводы. Раннее выявление признаков НДСТ и оптимизация ведения беременности и родов у пациенток с НДСТ будет способствовать улучшению перинатальных исходов.

Новая коронавирусная инфекция (COVID-19) вызывает обоснованные опасения по влиянию вируса SarsCoV-2 на беременных женщин и женщин в послеродовом периоде, учитывая высокий риск возникновения COVID-19-ассоциированного острого респираторного дистресс-синдрома с рефрактерной гипоксемией даже на фоне проведения искусственной вентиляции легких. При возникновении данной ситуации обосновано применение экстракорпоральной мембранной оксигенации (ЭКМО) для улучшения респираторной функции и поддержки кровообращения. В приведенном клиническом случае представлен опыт успешного лечения пациентки с инфекцией COVID-19 в раннем послеродовом периоде с проведением ЭКМО в течение 22 дней, находившейся на стационарном лечении в УЗ «Гродненский областной клинический кардиологический центр». В текущей клинической ситуации были последовательно использованы все методики респираторной поддержки: от оксигенотерапии через высокопоточную вентиляцию и неинвазивную искусственную вентиляцию легких (ИВЛ) до инвазивной ИВЛ. За время нахождения на ЭКМО у пациентки случилось два геморрагических события, потребовавших проведения оперативных вмешательств. За время терапии удалось избежать тромбоза контура и не допустить развития повторных кровотечений на фоне антикоагулянтной терапии путем тщательного мониторирования системы гемостаза при помощи клоттинговых гемостазиологических тестов и показателей ROTEM, осуществления коррекции их нарушений.

Meningiomas are benign tumors that grow slowly. Treatment of patients with brain tumors during pregnancy and in the postpartum period is an urgent problem of modern neurosurgery. The increase in fluid volume and reproductive hormones that occur during pregnancy can have a profound effect on tumor growth and neurological symptoms. Fortunately, these cases are quite rare. This is due to multiple risk factors for both mother and fetus. Timely diagnosis, multidisciplinary collegial approach, mobility of response to the course of the disease depending on the gestational age, choice of time, method of surgical intervention and delivery reduces the threat and contributes to a more favorable prognosis. In this case, a 34-year-old patient at 37 weeks of gestation was found to have a tumor in the right parietal region. After delivery by caesarean section, surgical treatment was performed - microsurgical total removal of the tumor with a favorable outcome. [ABSTRACT FROM AUTHOR]

Background. Inhibitory receptors and their ligands (also called checkpoint molecules) are important feedback regulators of the immune response. However, their role in immunological adaptation during pregnancy remains poorly understood.The aim of the study was to evaluate the level of checkpoint molecule (PD-1, CTLA-4, Tim-3) expression in peripheral T cells in pregnant women compared with fertile non-pregnant women.Materials and methods. The study included 36 women in the second half of pregnancy without pregnancy complications, 12 of whom had extragenital pathology. The control group consisted of 28 age-matched fertile non-pregnant women. The proportion of CD8+PD-1+, CD8+TIM-3+, CD8+PD-1+TIM-3+, CD4+PD-1+, CD4+TIM-3+, and CD4+PD-1+TIM-3+ was evaluated by flow cytometry using the corresponding monoclonal antibodies (BD Biosciences, USA).Results. The proportion of CD4+Tim-3+ and CD8+PD-1+ Т cells and CD4+ and CD8+ Т lymphocytes co-expressing PD-1 and Tim-3 in the peripheral blood of pregnant women was statistically significantly higher than in non-pregnant women. An increase in CD4+Tim-3+ and CD8+PD-1+ T cells was observed both in pregnant women with and without extragenital pathology. However, pregnant women with extragenital pathology were characterized by a higher CD8+PD-1+ count and a smaller number of CD8+Tim-3+ cells, as well as by a lack of an increase in PD-1+Tim-3+ T cells typical of pregnant women. The number of comorbidities was directly correlated with the proportion of CD8+PD-1+ lymphocytes and inversely correlated with the proportion of CD8+Tim-3+ and CD4+ PD-1+Tim-3+ cells. In addition, the expression of checkpoint molecules was associated with gestational age (a direct correlation was found with the proportion of CD8+Tim-3+, CD4+PD-1+Tim-3+, and CD8+PD-1+Tim-3+ cells) and to a lesser extent – with the age of pregnant women (an inverse relationship was found with the proportion of CD8+Tim-3+ cells).Conclusion. Pregnant women in the second half of pregnancy are characterized by increased expression of PD-1 and Tim-3 molecules in peripheral T cells. At the same time, concomitant extragenital pathology affects the expression of these molecules.

The aim of the research – the purpose of this work was to study of clinical and anamnestic characteristics of pregnant women with insufficient iodine supply, living in the region of natural mild iodine deficiency. Materials and methods. After establishing the thyroid status and the level of consumption of ioduria in 1119 pregnant women, an analysis of the social and clinical and anamnestic data of 465 pregnant women was carried out. Group I consisted of 406 pregnant women with urinary iodine excretion less than 100 µg/l, group II – 59 pregnant women with ioduria over 100 µg/l. Results. The presence of mild iodine deficiency (median ioduria was 76.27 μg/l) was found in the examined pregnant women living in the region of natural iodine deficiency. A high incidence of diseases of the cardiovascular and urinary systems, diseases of the ENT organs, neurocirculatory dystonia was noted in pregnant women of group I, compared with pregnant women of group II. When studying the gynecological and obstetric anamnesis, it was found that uterine leiomyoma and secondary infertility occurred only in pregnant women with iodine deficiency. Premature births in history, despite the absence of statistically significant differences, occurred 1.7 times, pathological births – 5 times more common in pregnant women with iodine deficiency, compared with pregnant women with a normal level of iodine supply, and late births and perinatal losses occurred. only in pregnant women with insufficient iodine intake. Conclusion. It has been established that living in a region of mild natural iodine deficiency in the absence of iodine supplementation is accompanied by the development of iodine deficiency in women during gestation. The lack of adequate iodine supplementation among women living in the region of iodine deficiency is accompanied by the formation of an unfavorable somatic and obstetric-gynecological background, which contributes to a negative impact both on the reproductive potential of a woman and on the course of subsequent pregnancies.

The aim of the study was to assess the levels of soluble fms-like tyrosine kinase 1 (sFlt1), placental growth factor (PlGF), and vascular endothelial growth factor A (VEGF-A) in tissue extracts in comparison with the histologic examination of the endometrium and chorionic villi in women with spontaneous abortion and active cytomegalovirus (CMV) infection.Materials and methods. 81 women at 7–9 weeks of pregnancy were examined: of them, 51 women were CMVseropositive with active infection and after spontaneous abortion, and 30 patients were CMV-seronegative, healthy women after therapeutic abortion. Immunoglobulins (Ig) M and G to CMV and CMV IgG avidity were measured in the blood plasma; sFlt1, PlGF, and VEGF-A were determined in extracts of chorionic villi by enzyme immunoassay. CMV DNA was detected in mononuclear cells of peripheral blood, urine, and chorionic villi by real-time polymerase chain reaction (PCR). A histologic examination of the endometrium and chorionic villi was carried out.Results. In chorionic villus extracts of women with spontaneous abortion and active CMV infection, the concentration of sFlt1 was 3.25 times higher (p < 0.001), and the levels of PlGF and VEGF-A were 1.31 (p < 0.001) and 2.16 times lower (p < 0.001) than in healthy women. A strong negative correlation was established between the levels of sFlt1 and PlGF (r = –0.702; p < 0.001) and VEGF-A (r = –0.858; p < 0.0005), and a positive correlation was revealed between PlGF and VEGF-A levels (r = 0.860; p < 0.001). According to the data of the histologic examination, a lag in decidual transformation of uterine vessels, trophoblast invasion, growth and differentiation of villi, and formation of fetal circulation was detected.Conclusion. The mechanisms of spontaneous abortion in women with active CMV infection include an imbalance of pro- and anti-angiogenic factors, which causes impaired placental development and uteroplacental circulation.

Moyamoya disease (a puff of smoke, fog) develops, as a rule, in children and adults of working age and consists in a slowly progressive narrowing of the lumen of the intracranial segments of the internal carotid artery, the initial sections of the anterior and middle cerebral arteries up to their complete occlusion. With a compensatory purpose, many small collaterals have time to form in the brain, which visually resemble a ball of smoke on brain angiograms. My-my disease is extremely rare (in Europe, USA, Japan, Africa), its prevalence even in the most endemic areas is only 0.35 per 100,000 population. This article describes a rare clinical case of Moyamoya disease in a pregnant woman. Considering the optimal chosen management tactics of the patient, a favorable outcome was obtained for the woman and fetus.

According to the Federal State Statistics Service, maternal mortality in the Russian Federation increased from 9.0 to 11.2 in 2020; in some subjects of the Russian Federation, this figure rises to 18.9, indicating the need for further analysis and implementation of the latest scientific data into practice. This review presents data from current publications on the clinical manifestations of coronavirus infection in pregnant women, problems of radiation diagnosis, and pregnancy complications. Among the latter, thromboembolic events, placental disorders caused by microthrombosis and the resulting increase in preterm labor and hypertensive disorders are the most common. A threefold increase in gestational hypertension and the development of preeclampsia in pregnant women infected with COVID-19 has been reported. Each day more and more evidence are comming for the effectiveness of low molecular weight heparins for the prevention of perinatal complications. Data are presented on the possible effect of additional folate and vitamin D supplementation on the course of new coronavirus infection in pregnant women. The issues of perinatal outcomes and prevention of complications remain the most relevant and require further study.

Despite low incidence of pregnancy-induced sacroiliitis, it is associated with significant morbidity and mortality. Sacroiliitis can be particularly difficult to diagnose because its symptoms are non-specific. A clinical case of postpartum sacroiliitis in a 24-year old patient is reported. The patient complained of severe right buttock pain radiating to the right thigh. In addition, the symptoms of systemic inflammatory response syndrome were present. Right-sided sacroiliitis was recognized by magnetic resonance imaging (MRI). Non-brucellar and non-tuberculous infectious sacroiliitis is a rare disease with misleading clinical signs that delay diagnosis. Most observations are based on individual case reports or small case series. Infectious sacroiliitis should be considered as a differential diagnosis even in low-risk women who present with debilitating pelvic pain during pregnancy and delivery. Thus, it may facilitate timely diagnosis and treatment.

Hereditary, exogenous, multifactorial factors lead to the occurrence of anomalies in the development of female genital organs. The occurrence of genital malformations is attributed to the critical period of intrauterine development. It is based on the absence of fusion of the caudal sections of the paramesonephral Muller ducts, deviations in the transformations of the urogenital sinus, as well as the pathological course of gonad organogenesis, which depends on the development of the primary kidney. These deviations account for 16 % of all anomalies. Anomalies in the development of female genital organs can occur under the influence of harmful environmental factors, occupational harmful effects in the mother, poisoning with toxic substances. Along with anomalies of the genitals, in 40 % of cases there are anomalies of the urinary system (unilateral kidney agenesis), intestines (atresia of the anus), bones (congenital scoliosis), as well as congenital heart defects. The presented article describes a clinical case of pregnancy and childbirth.

In recent decades, the interest of neurologists, psychiatrists, and doctors of other specialties in the problem of autoimmune encephalitis has been steadily increasing. Autoimmune encephalitis is a group of neurological diseases in which autoantibodies to the intra and extracellular structures of the neuron, which act as antigens, have been verified. The number of patients diagnosed with autoimmune encephalitis is growing, but the combination of autoimmune encephalitis and pregnancy is rare. We present to your attention our observation of a case of limbic encephalitis during pregnancy.

Введение. Лечение ожоговых поражений – одна из наиболее острых и актуальных проблем комбустиологии, несмотря на все достижения современной медицины. При ожогах кожи возникают множественные системные изменения, требующие особого внимания и новых подходов. Низкоинтенсивное лазерное облучение крови – высокоэффективный способ нефармакологического корригирующего воздействия на систему гомеостаза обожженных, но остается неизученным у беременных с термическими ожогами кожи. Цель исследования. Оценить эффективность низкоинтенсивного лазерного облучения крови для коррекции нарушений системы гомеостаза у беременных крыс с термическими ожогами кожи. Материал и методы. Экспериментальное исследование проводилось на 81 самке беспородных белых крыс массой 200-250 г, которые были разделены на три группы. Контрольную группу составили беременные интактные крысы, 1-ю опытную группу – крысы c термическим ожогом кожи в раннем периоде беременности, 2-ю опытную группу – крысы с термическим ожогом кожи в раннем периоде беременности, которым выполнялось низкоинтенсивное лазерное облучение крови. Изучались кислородтранспортная функция крови, кислотно-основное состояние и основные биохимические показатели крови. Результаты. Термические ожоги кожи у крыс в раннем периоде беременности сопровождаются ухудшением кислородтранспортной функции крови (снижение значений РО2 и SO2, уменьшение сродства гемоглобина к кислороду) и развитием метаболического ацидоза, а также наличием эндогенной интоксикации (рост концентрации мочевины и креатинина, повышение уровня печеночных ферментов). Применение низкоинтенсивного лазерного облучения крови позволяет в более короткие сроки улучшить показатели гомеостаза. Выводы. Низкоинтенсивное лазерное облучение крови улучшает основные показатели кислородтранспортной функции крови и снижает уровень эндогенной интоксикации при ожогах кожи у крыс в раннем периоде беременности.

COVID-19 leads to cytokine storm, systemic inflammatory response and coagulopathy, which is one of the worst prognostic factors. Coagulopathy in COVID-19 is accompanied by a pronounced increase in the level of D-dimer and degradation products of fibrin / fibrinogen, while deviations of other indicators (prothrombin time, activated partial thromboplastin time, platelet count) are relatively rare at the onset of the disease. All pregnant women are offered a screening test for coagulation, including the determination of the level of D-dimer and fibrinogen. For coagulopathy associated with COVID-19, empiric anticoagulant therapy is required to prevent venous thrombosis and thromboembolism, as well as standard maintenance therapy for sepsis-induced coagulopathy or disseminated intravascular coagulation syndrome.

The data available to date indicate that a new coronavirus infection can have an adverse effect on the course of pregnancy and may affect perinatal outcomes.

АКТУАЛЬНОСТЬ: Врачу — анестезиологу-реаниматологу при составлении плана анестезиологического обеспечения операции кесарева сечения необходимо знать о том, какие физиологические и функциональные особенности имеет беременная пациентка в том или ином сроке гестации. Правильное составление плана анестезии и тактики ведения пациенток в периоперационном периоде помогает снизить риск гемодинамических, респираторных и других критических инцидентов. ЦЕЛЬ ИССЛЕДОВАНИЯ: Поиск данных о способах и результатах оценки кардиореспираторного статуса беременных с использованием методов, задействующих такие ключевые механизмы рефлекторной регуляции, как артериальный барорефлекс (АБР) и периферический хеморефлекс (ПХР). МАТЕРИАЛЫ И МЕТОДЫ: Мы провели систематический обзор литературы в соответствии с рекомендациями PRISMA. Поиск был проведен в декабре 2022 г. в базах Medline (Pubmed), «Российский индекс научного цитирования» (РИНЦ, eLibrary.ru) и Cochrane Library. Поиск производился по запросам: «произвольное пороговое апноэ беременность», «хеморефлекс беременность», «барорефлекс беременность», «проба Вальсальвы беременность», «pregnancy breath holding test», «pregnancy chemoreflex», «pregnancy baroreflex», «Valsalva test pregnancy». РЕЗУЛЬТАТЫ: Было найдено 110 работ, после удаления по различным причинам 68 работ было проанализировано 42 полнотекстовых источника, в том числе проведен подробный сравнительный анализ 8 источников, полностью соответствующих критериям включения. Дизайн, цели, методы, доступность данных и конечные результаты исследований были неоднородными, поэтому метаанализ данных не проводился. Были извлечены и обобщены данные о функциональных изменениях в работе кардиореспираторной системы, происходящих при беременности и отражающихся в изменении чувствительности АБР и ПХР. ВЫВОДЫ: Чувствительность ПХР у беременных можно оценивать с помощью вдыхания гипероксической, гиперкапнической и изооксически-гиперкапнической газовой смеси (варианты пробы с возвратным дыханием). Чувствительность АБР у беременных можно оценивать с помощью фенилэфринового теста пробы Вальсальвы, ортостатической пробы, а также спектрального анализа последовательностей значений артериального давления и интервала R–R. Чувствительность ПХР при доношенной беременности увеличивается. Чувствительность АБР у беременных прогрессивно снижается от начала беременности до конца II триместра и повышается в послеродовом периоде до исходного уровня; в III триместре беременности изменения чувствительности АБР носят индивидуальный характер и не имеют единой тенденции.

The intergenetic interval is the time interval between the birth of a child and the onset of the next pregnancy. WHO (2018) regulates the optimal intergenetic interval between two consecutive births lasting 24 + 9 months (the time interval between childbirth and the next conception plus 9 months of gestation). Non-compliance with AI negatively affects the course of pregnancy, the outcomes of childbirth for both the mother and the fetus.

Objective – to study the course of pregnancy, the outcomes of childbirth and the postpartum period in young women. Materials and methods. A retrospective analysis of the medical histories of 400 women in the State Medical Institution «Kuzbass Clinical Hospital named after S. V. Belyaev», «Perinatal Center», Kemerovo, for the period from 2015 to 2018 was carried out. The main group included 200 girls under the age of 18, the control group – 200 girls aged 20-25 years. The course of pregnancy, complications of childbirth and the postpartum period were evaluated. The obtained data were processed using the Statistics 6.0 program. The critical level of significance of the differences was estimated as p, equal to or greater than 0.05. Results. It was found that young primiparous women were somatically healthier than girls in the group of favorable reproductive age. The most frequent complications of pregnancy were gestational anemia and pyelonephritis, less often early toxicosis, gestacin diabetes mellitus and the threat of termination of pregnancy. In minors, compared with 20-25-year-old women in labor, preterm labor, induced, operative labor by emergency caesarean section and benefits in childbirth are more common, and birth injuries are less common. There are differences in the indications for planned surgical treatment. Less often, complications of the late postpartum period in the form of subinvolution of the uterus and lochiomyoma. Anthropometric indicators and Apgar score at birth in newborns are the same. Conclusion. The course of pregnancy, childbirth and the postpartum period in young people has its own characteristics. Premature, induced, and operative births were more common in young women. However, in the young, the late postpartum period was more favorable. There were no differences in the outcome of labor for the fetus.

Background. Gastric and duodenal ulcers are extremely rare in pregnancy, according to published literature. Peptic ulcer is found in 1 per 4,000 pregnant women, a figure probably underestimated due to its hampered diagnosis in pregnancy. Pregnancy peptic ulcer is considered less expected. Perforated gastric and duodenal ulcers comprise about 1.5 % of total acute abdominal diseases, and the perforation rate in ulcer patients ranges within 5–15 %. This complication afflicts the ages of 20–40 years in men much more frequently than in women. Three perforation types occur: free into abdominal cavity (87 %), contained (9 %), into lesser omentum and retroperitoneal tissue (4 %).Materials and methods. The clinical case describes surgical management of posttraumatic diaphragmatic hernia-comorbid perforated gastric ulcer in a pregnant woman in third trimester. Surgery with postoperative patient management enabled for a favourable outcome.Results and discussion. Perforation-entailing gastric and duodenal ulcers in pregnant women have received negligible attention due to rarity in clinical practice. Paul et al. described 14 cases of duodenal perforation in pregnancy, all fatal.Conclusion. Early diagnosis of surgical pathology during gestation is still difficult contributing to the development of severe complications associated with high mortality. The patient’s admission to a level III interspecialty hospital was key to enable a timely consilium-driven decision of caesarean intervention for saving the child, diagnosing intraoperatively life-threatening complicated surgical diseases and opting for radical surgery that ended in a favourable outcome.

Введение. В современной медицине проблема лечения термических ожогов кожи у беременных остается актуальной в связи с недостаточным исследованием патологических процессов, происходящих в организме будущей матери с термическим поражением. Цель исследования. Оценить состояние гомеостаза у крыс с термическим ожогом кожи в среднем периоде беременности. Материал и методы. Экспериментальное исследование проводилось на 36 самках беспородных белых крыс массой 250-350 г, которым производился термический ожог кожи в среднем периоде беременности. Изучались процессы перекисного окисления липидов и суммарное содержание нитрат/нитритов, исследовались кислородтранспортная функция крови и основные биохимические показатели крови. Результаты. Термический ожог кожи у крыс в среднем периоде беременности приводит к развитию гипоксии, судя по уменьшению значений рO2 и SO2, а также к уменьшению сродства гемоглобина к кислороду. При этом развивается окислительный стресс, а также наблюдается увеличение содержания нитрат/нитритов, что отражает нарушения функционирования L-аргинин-NО системы, обуславливая изменения кислородсвязывающих свойств крови и формируя прооксидантно-антиоксидантный дисбаланс. Изменения основных биохимических показателей крови подтверждают наличие эндогенной интоксикации. Выводы. Выявленные нарушения гомеостаза у беременных крыс с термическим ожогом кожи свидетельствуют о важной роли кислородзависимых процессов в патогенезе термической травмы, что необходимо учитывать при разработке соответствующих мероприятий, направленных на устранение нарушений данной патологии.

The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic syndrome, which may, infrequently, become severe and evenly fatal. Although the milder form is more common, particularly among patients undergoing gonadotropin stimulation for assisted reproductive technology, the severe form is rare. Unfortunately, there is currently no available way to predict this syndrome. This article aims develop a method for individual prediction of ovarian hyperstimulation syndrome. The aim of the study is to develop a method for individual prediction of ovarian hyperstimulation syndrome, based on socio-biological data, clinical and laboratory examination data and data obtained during ultrasound examination of the pelvic organs before entering the IVF protocol and during ovulation stimulation. Materials and methods. An analysis of 671 treatment cycles under the IVF program was carried out, among which 56 cycles were complicated by hyperstimulated ovarian syndrome. Results and its discussion. The aim of this study was to evaluate risk factors for development ovarian hyperstimulati on syndrome, which we considered in the aggregate with each other. Based on this, a method for individual prediction of the syndrome has been developed. Conclusions. We have developed a method for individual prediction of ovarian hyperstimulation syndrome with a sensitivity 93.9 %.

Methods. The changes in endothelial NO-synthase (eNOS) were studied as a manifestation of endothelial dysfunction in 670 pregnant women, depending on arterial hypertension (AH) and smoking. Chronic hypertension had 313 pregnant women, 20 % of women included in the study smoked. All women are divided into 4 groups. Group 1 (control) included 313 healthy non-smoking pregnant women without AH, the second group included 250 non-smoking pregnant women with AH, the group 3 included 45 smoking pregnant women without AH, group 4 included 62 smoking pregnant women with AH. The groups did not differ in average age and gestational age. Endothelial NO-synthase was measured in blood serum by using a RayBiotech reagent (RayBio Human eNOS ELISA Kit) by a plate method. Results. It was found that in the group 2 the level of eNOS was 30.7 % lower than in the control group, but this difference was no statistically significant (2.6 ng/ml versus 1.8 ng/ml, p = 0.014). In the group 3 the level of eNOS was statistically significantly lower than in the control group: 1.3 (0.3-2.5) ng/ml versus 2.6 (1.6-9.4) ng/ml (p = 0.01). In the group 3 level of eNOS was 27.8 % lower than in the group 2, however, this difference were no statistically significant: 1.3 (0.3-2.5) versus 1.8 (1.0-3.4), p = 0.19. The lowest level of NO-synthase was registered in the group 4 (AH + smoking) – 0.6 (0.1-1.0) ng/ml. It is statistically significantly lower than in the control group (p < 0.001), in the group 2 – 1.8 (1.0-3.4) ng/ml (p = 0.001) and in the group 3, respectively – 1.3 (0.3-2.5) ng/ml (p = 0.02). Conclusions. Smoking and especially smoking in combination with arterial hypertension caused a significant decrease in endothelial NO-synthase in pregnant women, which indicates the development of endothelial dysfunction.

Objective – the state of health of pregnant women at a large metallurgical enterprise. The aim of the study is a medical and demographic assessment of the effectiveness of the early provision of social maternity leave at a large metallurgical enterprise in the Sverdlovsk region. Methods: The materials of the statistical reports of the antenatal clinic of the medical and sanitary unit of the enterprise for 1991-2020 were used. The indicators of the health status of pregnant women are presented in dynamics and in comparison with the Russian Federation and the Sverdlovsk region. Main results. Favorable changes in the health status of pregnant women were noted: an increase in the number of births, the absence of abortions in terms of social indicators, registration for pregnancy, a decrease in the frequency of the threat of abortion, preeclampsia, the absence of cases of eclampsia and intrapartum fetal death, a decrease in morbidity with temporary disability associated with complications pregnancy, childbirth and the postpartum period. Within 7-9 years after the introduction of early social leave, there was a decrease in the prevalence of anemia in pregnant women, the incidence of premature births and congenital malformations of the fetus. Conclusions. 1. The early provision of social maternity leave at the metallurgical enterprise served to improve the health of pregnant women and newborns, optimized the provision of timely specialized medical care, and reduced the number of people with life-threatening conditions and clinical situations complicating the course of pregnancy. 2. Medico-demographic analysis of the experience of providing early social leave allows us to recommend their introduction at other enterprises in the country, first of all, with harmful working conditions.

A clinical case of HIV-associated multiple drug resistant tuberculosis in a pregnant woman is presented. The clinical situation was complicated since during the main course of treatment this patient had two pregnancies and delivery with an interval of less than 2 years, and the onset of the disease occurred during the early period in the first pregnancy. This case demonstrates effective treatment of the specific disease and favorable perinatal outcomes. The article assesses medical tactics, analyzes the time of diagnosis, complex therapy, the choice of the way of delivery, considers the need for interdisciplinary interaction at all stages of observation to improve the quality of care.

The incidence of severe sepsis with fatal outcomes increases annually by 10%, mortality remains high, and its treatment is accompanied by high costs. In developing countries, septic shock occupies a leading place in the causes of maternal mortality, despite preventive measures and successes in the treatment of purulent-septic complications in obstetrics. In the Russian Federation, maternal mortality associated with sepsis during childbirth and in the postpartum period in the general structure reaches 3.6 %.

Cervical cancer is among the top ten most common cancers and ranks 5th. Morbidity and mortality from this pathology have significantly decreased in recent years due to the introduction of modern and accurate diagnostic methods and mass screening of women. Every year, about 500000 new cases of the disease are detected in the world, including 15000 in Russia. This disease accounts for an average of 4.4 % in developed countries, 5.2 % in the Russian Federation, and up to 15 % in developing countries. Experts note a negative trend in the incidence of cervical cancer, as cases of its occurrence at a young age have become more frequent. In most cases, cervical cancer occurs in women aged 50-60 years, but in recent decades, statistics indicate a shift in the lower age limit of this type of cancer to 37-40 years and below. This article describes a clinical case of pregnancy and childbirth in a woman after suffering from cervical cancer. Taking into account the optimal chosen management tactics of the patient, a favorable outcome of pregnancy and childbirth for the mother and fetus was obtained.

Gigantomastia (macromastia, hypermastia) is a rare disease associated with excessive hypertrophy of the connective tissue of the breast in women. Gestational gigantomastia is a type of disease, the most common type. It develops during pregnancy under the influence of hormonal surges of progesterone, prolactin, and estradiol. More often, gigantomastia is bilateral, less often-unilateral. The disease occurs in one case per 28000-100000 pregnancies. As a rule, the condition develops in the first trimester under the influence of placental hormones. The consequences of the disease are more often observed in women with multiple pregnancies. Approximately 150 cases of gestational gigantomastia have been reported. After childbirth, in some cases, the breasts return to their postpartum state, but with subsequent pregnancy they increase again, usually more significantly. The condition threatens the health of the mother, but has a good outcome for the fetus. Despite the benign nature of gigantomastia, it can cause a dangerous condition and even death from severe infection and cardiopulmonary failure. This article describes a rare clinical case of gestational gigantomastia. Taking into account the optimal chosen management tactics of the patient, a relatively favorable outcome of pregnancy and childbirth for the mother and fetus was obtained.

Background. Ovarian cancer in pregnancy is quite rare having a top 5th incidence among other pregnancy-associated tumours [1]. Due to a low population rate in pregnant women, the lack of standardised management of such patients and the paucity of relevant randomised and cohort studies, analyses of individual clinical cases acquire particular importance.Materials and methods. This article presents a clinical case of de novo diagnosed ovarian cancer in pregnancy tackled with a modified Porro’s operation of peritonectomy, para-aortic and parametric lymphadenectomy and greater omentum resection at a gynaecology unit of the Kuvatov Republican Clinical Hospital of Ufa.Results and discussion. This clinical case is special in terms of a rare occurrence of ovarian cancer in pregnancy. The choice of this radical surgical technique is considered optimal for inspecting most plausible metastatic foci and ensuring a life-preserving prognosis.Conclusion. In the absence of standardised management protocols in pregnancy-associated ovarian cancer, further analyses and discussions of routine clinical case evidence are imperative.

The purpose of our study was to obtain ranges of basic parameters of body composition in physiologically occurring pregnancy in women without obesity at different gestation periods. To achieve this goal, a prospective cohort study of 195 women from 7 to 40 weeks of gestation living in the Yaroslavl region was conducted. All subjects underwent a standard clinical examination in accordance with the Order of the Ministry of health of the Russian Federation dated November 1, 2012. N 572N and bioimpedance analysis of body composition using the analyzer for evaluating the balance of water sectors of the body with the software ABC-01 «MEDAS». Normative data on the resistance of biological tissues were obtained, as well as the main parameters of body composition at different gestation periods were calculated. Dynamic observation during the entire pregnancy and analysis of the birth history were performed. The obtained data will allow us to analyze the peculiarities of adaptation of a woman's body to pregnancy, as well as to identify pathological changes in the body composition in the early stages of gestation, which can be predictors of the development of obstetric pathology in later pregnancy.

New technologies are opening up promising opportunities for the treatment of type I diabetes during pregnancy. Recent evidence suggests that continuous glucose monitoring (CGM) should be offered to all women receiving intensive insulin therapy early in pregnancy, which records changes in blood glucose concentration every 5 minutes over a long period of time. Despite studies comparing insulin pump therapy with multiple daily injections of insulin, its effectiveness in reducing the incidence of hyperglycemia and hypoglycemia, lowering glycated hemoglobin (HbA1) levels, weight control and pregnancy outcomes remains unclear. Sensor-integrated insulin delivery (also called artificial pancreas or feedback insulin delivery) during pregnancy has been shown to improve time to goal and works well despite changing insulin requirements during pregnancy.

The incidence of venous thromboembolic complications during pregnancy and the postpartum period is up to 5 cases per 1000 women. Deep vein thrombosis of the lower extremities and associated thromboembolism of the pulmonary artery are a serious problem in modern medicine, complicates the course of the gestational process, posing a threat to the health of women and the fetus, often necessitates surgical interventions, and leads to an increase in maternal and perinatal mortality. Most cases of deep vein thrombosis of the lower extremities are diagnosed in the second half of pregnancy and in the first two weeks of the postpartum period.

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