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The development of assisted reproductive technologies (ART) today allows many women to overcome biological barriers to motherhood. However, the use of such relatively new areas as oocyte donation and surrogacy, which result in the formation of an allogeneic fetus, is associated not only with legal but also with medical problems. Purpose - to analyze the clinical characteristics of pregnant women with an allogeneic fetus and pregnant women who were involved in ART programs with their own oocytes. Materials and methods. 120 pregnant women were examined, who were divided into the following groups: the Group I - 40 pregnant women who were involved in ART programs using foreign oocytes with the formation of an allogeneic fetus and whose management is planned to be carried out according to an improved algorithm; the Group II - 40 pregnant women who were involved in ART programs using foreign oocytes with the formation of an allogeneic fetus and whose management is planned to be carried out according to the generally accepted algorithm; the Group III - 40 pregnant women who underwent ART using the woman's own oocytes. The features of reproductive and somatic history, as well as social and demographic factors of the patient’s lives, were established. Results. Among pregnant women with an allogeneic fetus, a significantly higher proportion of women with pelvic inflammatory disease, bacterial vaginosis, cervical pathology, as well as patients with a history of surgical termination of pregnancy at the woman’s request were recorded. At the same time, the rates of registration of late menarche, endometriosis, polycystic ovary syndrome, early spontaneous abortions, as well as the following extragenital pathology: chronic arterial hypertension, diseases of the urinary system, and diabetes mellitus were significantly lower in patients of the Groups I and of the Groups II. The following social and demographic features of patients with an allogeneic fetus were noted: a smaller proportion of women with higher education, as well as those who live in their own home and are in a registered marriage compared to the control group. Conclusions. Registration of higher levels of a number of gynecological complications in pregnant women with an allogeneic fetus, as well as unfavorable social and demographic factors, requires the development of an improved management algorithm for such women, taking into account these features, which can help to reduce the rates of various obstetric and perinatal complications. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author., Развитие вспомогательных репродуктивных технологий (ВРТ) на сегодняшний день позволяет многим женщинам преодолеть биологические барьеры на пути к материнству. Однако использование таких относительно новых направлений, как донация ооцитов и суррогатное материнство, результирующих в формирование алогенного плода, связано не только с юридическими, но и с медицинскими проблемами. Цель - проанализировать клиническую характеристику беременных с аллогенным плодом и беременных, вовлеченных в программы ВРТ с использованием собственных ооцитов. Материалы и методы. Обследованы 120 беременных женщин, поделенных на группы: I группа - 40 женщин, беременность у которых наступила в результате ВРТ с использованием чужих ооцитов с формированием алогенного плода и ведение которых планируется по усовершенствованному алгоритму; II группа - 40 женщин, беременность у которых наступила в результате ВРТ с использованием чужих ооцитов с формированием алогенного плода и ведение которых планируется по общепринятому алгоритму; ІІІ группа - 40 пациенток, у которых беременность наступила в результате ВРТ с использованием собственных ооцитов. Результаты. Среди беременных с аллогенным плодом регистрировалась достоверно более высокая доля женщин с воспалительными заболеваниями органов малого таза, бактериальным вагинозом, патологией шейки матки, а также с прерыванием беременности по желанию женщины хирургическим методом в анамнезе. В то же время, у пациенток I и II групп достоверно ниже были показатели регистрации позднего менархе, эндометриоза, синдрома поликистозных яичников, самопроизвольных выкидышей в ранних сроках, а также следующей экстрагенитальной патологии: хронической артериальной гипертензии, заболеваний мочевыделительной системы, сахарного диабета. Отмечались следующие социально-демографические особенности пациенток с аллогенным плодом: меньшая доля женщин с высшим образованием, а также проживающих в собственном доме и состоящих в зарегистрированном браке по сравнению с контрольной группой. Выводы. Регистрация у беременных с аллогенным плодом высших уровней ряда осложнений гинекологического анамнеза, а также неблагоприятных социально-демографических факторов требует разработки усовершенствованного алгоритма ведения таких женщин с учетом данных особенностей, что может способствовать снижению частоты различных акушерских и перинатальных осложнений. Исследование выполнено в соответствии с принципами Хельсинкской декларации. Протокол исследования одобрен Локальным этическим комитетом участвующего учреждения. На проведение исследований получено информированное согласие женщин. Автор заявляет об отсутствии конфликта интересов., Розвиток допоміжних репродуктивних технологій (ДРТ) на сьогодні дає змогу багатьом жінкам подолати біологічні бар’єри на шляху до материнства. Однак застосування таких відносно нових напрямів, як донація ооцитів і сурогатне материнство, що результують у формування алогенного плода, пов’язане не лише з юридичними, але й власне медичними проблемами. Мета - проаналізувати клінічну характеристику вагітних з алогенним плодом і вагітних, залучених до програм ДРТ із використанням власних ооцитів. Матеріали та методи. Обстежено 120 вагітних жінок, поділених на групи: І група - 40 жінок, вагітність у яких настала в результаті ДРТ з використанням чужих ооцитів із формуванням алогенного плода та ведення яких планується за вдосконаленим алгоритмом; ІІ група - 40 жінок, вагітність у яких настала в результаті ДРТ з використанням чужих ооцитів із формуванням алогенного плода та ведення яких планується за загальноприйнятим алгоритмом; ІІІ група - 40 пацієнток, у яких вагітність настала в результаті ДРТ з використанням власних ооцитів. Встановлено особливості репродуктивного та соматичного анамнезу, а також соціально-демографічні фактори життя пацієнток. Результати. Серед вагітних з алогенним плодом реєструвалася достовірно вища частка жінок із запальними захворюваннями органів малого таза, бактеріальним вагінозом, патологією шийки матки, а також із перериванням вагітності за бажанням жінки хірургічним методом в анамнезі. Водночас у пацієнток І і ІІ груп достовірно нижчими були показники реєстрації пізнього менархе, ендометріозу, синдрому полікістозних яєчників, самовільних викиднів у ранніх термінах, а також екстрагенітальної патології: хронічної артеріальної гіпертензії, захворювань сечовидільної системи, цукрового діабету. Відмічалися такі соціально-демографічні особливості пацієнток з алогенним плодом: менша частка жінок із вищою освітою, а також тих, хто проживає у власному помешканні та перебуває в зареєстрованому шлюбі, порівняно з контрольною групою. Висновки. Реєстрування серед вагітних з алогенним плодом вищих рівнів багатьох ускладнень гінекологічного анамнезу, а також несприятливих соціально-демографічних факторів потребує розроблення вдосконаленого алгоритму ведення таких жінок з урахуванням цих особливостей, що може сприяти зниженню частоти різних акушерських і перинатальних ускладнень. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду жінок. Автор заявляє про відсутність конфлікту інтересів.

In recent years, endocrinopathy, in particular, and body weight deficiency have taken an important place in the structure of genital and extragenital pathology. Background somatic diseases are a risk factor for pregnancy loss, but the detailed mechanisms of influence on the course of pregnancy and childbirth in patients with body weight deficiency have not been studied. The objective:to evaluate the clinical and laboratory parameters of pregnant women with body weight deficiency. Materials and methods.A clinical, laboratory and functional examination of 200 pregnant women with body weight deficiency and 30 pregnant women with normal body weight was carried out. Body mass index (BMI) was calculated according to A. Ketle formula. Results.In women with body weight deficiency before pregnancy, the reduction in nutrition (BMI 19.1±0.4kg/m2) was 50%, hypotrophy of the I degree (BMI 18.0±0.5kg/m2) – 41% and hypotrophy of the II–III degrees (BMI 16.3±0.9kg/m2) – 9%. It was established that the total frequency of genital pathology before pregnancy in women with a body weight deficiency was 51.5%, among which menstrual cycle disorders predominated (16.5%). It was found that in pregnant women with a body weight deficiency, the increase in body weight occurs mainly (70–80%) due to lean body mass. During the assessment of clinical and biochemical indicators, no significant differences were found in the levels of hemoglobin, glucose, total protein and blood cholesterol compared to the indicators of women with normal body weight. However, a high frequency of hypocalcemia (71.7–92.8%), which correlates with the degree of hypotrophy, was found in women with body weight deficiency. Conclusions.Pregnant women with body weight deficiency are characterized by a high cumulative frequency of genital pathology before pregnancy, the absence of reliable changes in the levels of hemoglobin, glucose, total protein and blood cholesterol, and the presence of hypocalcemia.

In recent years, endocrinopathy, in particular, and body weight deficiency have taken an important place in the structure of genital and extragenital pathology. Background somatic diseases are a risk factor for pregnancy loss, but the detailed mechanisms of influence on the course of pregnancy and childbirth in patients with body weight deficiency have not been studied. The objective: to evaluate the clinical and laboratory parameters of pregnant women with body weight deficiency. Materials and methods. A clinical, laboratory and functional examination of 200 pregnant women with body weight deficiency and 30 pregnant women with normal body weight was carried out. Body mass index (BMI) was calculated according to A. Ketle formula. Results. In women with body weight deficiency before pregnancy, the reduction in nutrition (BMI 19.1±0.4 kg/m2) was 50%, hypotrophy of the I degree (BMI 18.0±0.5 kg/m2) – 41% and hypotrophy of the II–III degrees (BMI 16.3±0.9 kg/m2) – 9%. It was established that the total frequency of genital pathology before pregnancy in women with a body weight deficiency was 51.5%, among which menstrual cycle disorders predominated (16.5%). It was found that in pregnant women with a body weight deficiency, the increase in body weight occurs mainly (70–80%) due to lean body mass. During the assessment of clinical and biochemical indicators, no significant differences were found in the levels of hemoglobin, glucose, total protein and blood cholesterol compared to the indicators of women with normal body weight. However, a high frequency of hypocalcemia (71.7–92.8%), which correlates with the degree of hypotrophy, was found in women with body weight deficiency.Conclusions. Pregnant women with body weight deficiency are characterized by a high cumulative frequency of genital pathology before pregnancy, the absence of reliable changes in the levels of hemoglobin, glucose, total protein and blood cholesterol, and the presence of hypocalcemia., В останні роки ендокринопатії, зокрема і дефіцит маси тіла, посідають вагоме місце у структурі генітальної та екстрагенітальної патології. Фонові соматичні захворювання є чинником ризику невиношування вагітності, проте детальні механізми впливу на перебіг гестації та пологів у пацієнток з дефіцитом маси тіла не вивчені.Мета дослідження: оцінювання клініко-лабораторних особливостей у вагітних із дефіцитом маси тіла.Матеріали та методи. Проведено клініко-лабораторне і функціональне обстеження 200 вагітних з дефіцитом маси тіла та 30 вагітних із нормальною масою тіла. Індекс маси тіла (ІМТ) вираховували за формулою А. Кетле. Результати. У жінок із дефіцитом маси тіла до вагітності зниження харчування (ІМТ 19,1±0,4 кг/м2) становило 50%, гіпотрофія І ст. (ІМТ 18,0±0,5 кг/м2) – 41% та гіпотрофія ІІ–ІІІ ст. (ІМТ 16,3±0,9 кг/м2) – 9%. Установлено, що сумарна частота генітальної патології до вагітності у жінок із дефіцитом маси тіла становила 51,5%, серед якої переважають розлади менструального циклу (16,5%). Виявлено, що у вагітних із дефіцитом маси тіла збільшення маси тіла відбувається переважно (70–80%) за рахунок худої маси. Під час оцінювання клініко-біохімічних показників не встановлено достовірних відмінностей у рівнях гемоглобіну, глюкози, загального білка і холестерину крові щодо показників жінок із нормальною масою тіла. Проте виявлено високу частоту гіпокальціємії (71,7–92,8%), яка корелює зі ступенем гіпотрофії, у жінок із дефіцитом маси тіла. Висновки. Для вагітних із дефіцитом маси тіла характерним є висока сумарна частота генітальної патології до вагітності, відсутність достовірних змін рівнів гемоглобіну, глюкози, загального білка і холестерину крові та наявність гіпокальціємії.

The objective was to determine the mean morphometric characteristics of the rectovaginal septum (RVS) and its variations in correlation with the number of pregnancies, method of delivery, parity, and estrogenic exposure. An observational, cross-sectional, retrospective, descriptive, and comparative study was carried out. Pelvic MRI of Hispanic women (≥15 years of age) from the northeast of Mexico were obtained. Age and obstetric and gynecological history were registered and the sample women were categorized by their variables. Length and thickness measurements were standardized. A total of 102 MRI studies were included, with a mean age of 41; 24.5% were nulligravida, the rest primi- or multigravida. Vaginal delivery was the most common type (49.35%), 16.88% had a cesarean section, and 31.17% had mixed delivery. 74.5% of the women were premenopausal. The mean RVS length was 73.2 ± 15.3 mm, with a thickness of 2.8 ± 1.7, 2.2 ± 1.2, and 2.5 ± 1.3 mm for the upper, middle, and lower thirds respectively. There were tendencies to increase the length of the RVS, and the thickness of the upper and middle thirds in the non-pregnancy and the at-least-one-pregnancy groups; to increase the length and middle-third thickness in those with mixed delivery, and increased upper- and lower-third thickness in those with only a cesarean section. Multiparous women with vaginal delivery had significantly longer and thicker RVS than primiparous. Premenopausal women had significantly longer RVS with a tendency to lose thickness toward postmenopause. The morphology of RVS can be modified by different factors such as age, number of pregnancies, number of births, and estrogenic exposure. This structure should be evaluated and taken into account in preoperative management and surgical technique planning.

THE CURRENT STATE OF THE PROBLEM OF PERINATAL PSYCHOSOMATIC DISORDERS IN PREGNANT WOMEN Scherbina N., Potapova L., Scherbina I., Lipko O., Mertsalova O. Objective: to study the characteristics of the psychosomatic state of women during pregnancy using the Edinburgh Postpartum Depression Scale (EPDS). Materials and Methods: sixty pregnant women in the III trimester of pregnancy were tested using the EPDS questionnaire, a 10-point self-assessment scale that covers the general symptoms of depression. To determine the internal consistency and reliability of this scale, the Cronbach alpha indicator, a statistical indicator that allows evaluation of whether the features included in the questionnaire measure the same thing (high internal agreement), or different things (low internal agreement), was calculated. Results: Subjectively, all pregnant women noted simplicity, unambiguity and clear wording of the questions, which indicated good acceptability of this questionnaire for the use in the complex of standard monitoring of pregnant women in an antenatal clinic. The Cronbach alpha coefficient was 0.775, which corresponds to a sufficient degree of consistency of the internal elements of the scale. Screening for depressive disorders using EPDS during pregnancy revealed psychosomatic problems of the perinatal period. Data obtained using this scale demonstrate high rates of depressive manifestations in pregnant women. Psychopathological disorders were detected in 40% of women, while in 23% the symptoms of the current "major" depression were identified. The frequency of development of depressive symptoms increases significantly in the presence of a high obstetric risk, characteristic of the current pregnancy (threat of premature birth, hypertensive disorders during pregnancy, intrauterine infection of the fetus, retardation of the fetus development), as well as compromised obstetric and gynecological history. EPDS can be used as a reliable diagnostic tool to prevent pregnancy-related adverse outcomes. Conclusions: identifying the risk factors of pregnancy, screening and examining psychosomatic symptoms with EPDS, and timely referral for psychiatric care are key issues for reducing the risk among women with psychosomatic disorders during pregnancy and the postpartum period. Keywords: pregnancy, psychosomatic disorders, Edinburgh postpartum depression scale. Абстракт. СУЧАСНИЙ СТАН ПРОБЛЕМИ ПЕРИНАТАЛЬНИХ ПСИХОСОМАТИЧНИХ РОЗЛАДІВ У ВАГІТНИХ. Щербина М., Потапова Л., Щербина I., Ліпко О., Мерцалова О. Мета дослідження: вивчити особливості психосоматичного стану жінок під час вагітності з використанням Единбурзької шкали післяпологової депресії (EPDS). Матеріали і методи: проведено тестування за опитувальником EPDS 60 вагітних жінок в III триместрі вагітності. EPDS є шкалою самооцінки, складається з 10 пунктів охоплює загальну симптоматику депресії. Для визначення внутрішньої узгодженості і надійності зазначеної шкали розраховувався показник альфа Кронбаха, статистичний показник, що дозволяє оцінити вимірюють чи ознаки, що входять в опитувальник одне і те ж (висока внутрішня згода, або різні речі (низький внутрішній згоду). Результати дослідження: суб'єктивно все вагітні відзначали простоту, однозначність і зрозумілу формулювання питань, що свідчило про хорошу прийнятності даного опитувальника для застосування в комплексі стандартного спостереження за вагітними в жіночій консультації. Значення коефіцієнта альфа Кронбаха склало 0,775, що відповідає достатньому ступені узгодженості внутрішніх елементів шкали. Проведений скринінг на наявність депресивних розладів за допомогою EPDS під час вагітності дозволив виявити психосоматичні проблеми перинатального періоду. Дані, отримані на основі застосування цієї шкали демонструють високі показники присутності депресивних проявів у вагітних жінок. Психопатологічні розлади виявлено у 40% жінок, при цьому у 23% визначені симптоми поточної «великої» депресії. Частота розвитку депресивних симптомів значно підвищується при наявності високого акушерського ризику, характерного для поточної вагітності (загроза передчасних пологів, гіпертензивні порушення під час вагітності, внутрішньоутробне інфікування плода, ретардація плода), а також обтяженого акушерського і гінекологічного анамнезів. EPDS може бути використана як надійний діагностичний інструмент для попередження несприятливих наслідків, пов'язаних з вагітністю. Висновок: виявлення факторів ризику вагітності, скринінг і вивчення психосоматичних симптомів у вагітних із використанням EPDS, а також своєчасне направлення для надання психіатричної допомоги, є ключовими питаннями зниження ризику серед жінок з психосоматичними розладами під час вагітності та в післяпологовому періоді. Ключові слова: вагітність, психосоматичні розлади, Единбурзька шкала післяродової депресії. Абстракт СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ ПЕРИНАТАЛЬНЫХ ПСИХОСОМАТИЧЕСКИХ РАССТРОЙСТВ У БЕРЕМЕННЫХ. Щербина Н., Потапова Л., Щербина И., Липко О., Мерцалова О. Цель исследования: изучить особенности психосоматического состояния женщин во время беременности с использованием Эдинбургской шкалы послеродовой депрессии (EPDS).Материалы и методы: проведено тестирование по опроснику EPDS 60 беременных женщин в III триместре беременности. EPDS является шкалой самооценки, состоит из 10 пунктов и охватывает общую симптоматику депрессии. Для определения внутренней согласованности и надежности указанной шкалы рассчитывался показатель альфы Кронбаха, статистический показатель, позволяющий оценить измеряют ли признаки, входящие в опросник одно и то же (высокое внутреннее согласие, или разные вещи (низкое внутреннее согласие). Результаты исследования: Субьективно все беременные отмечали простоту, однозначность и понятную формулировку вопросов, что свидетельствовало о хорошей приемлемости данного опросника для применения в комплексе стандартного наблюдения за беременными в женской консультации. Значение коэффициента альфа Кронбаха составило 0,775, что соответствует достаточной степени согласованности внутренних элементов шкалы. Проведенный скрининг на наличие депрессивных расстройств с помощью EPDS во время беременности позволил выявить психосоматические проблемы перинатального периода. Данные, полученныена основе применения этой шкалы демонстрируют высокие показатели присутствия депрессивных проявлений у беременных женщин. Психопатологические расстройства выявлены у 40% женщин, при этом у 23% определены симптомы текущей «большой» депрессии. Частота развитии депрессивных симптомов значительно повышается при наличии высокого акушерского риска, характерного для текущей беременности (угроза преждевременных родов, гипертензивные нарушения во время беременности, внутриутробное инфицирование плода, ретардация плода), а также отягощенного акушерского и гинекологического анамнезов. EPDSможет быть использована как надежный диагностический инструмент для предотвращения неблагоприятных исходов, связанных с беременностью. Заключение: выявление факторов риска беременности и родов, скрининг и изучение психосоматических симптомов cиспользованием EPDS, а также своевременное направление для оказания психиатрической помощи, являются ключевыми вопросами снижения риска среди женщин с психосоматическими расстройствами во время беременности и в послеродовом периоде. Ключевые слова: беременность, психосоматические расстройства, Эдинбургская шкала послеродовой депрессии.

The article presents a unique clinical observation of adrenocortical cancer (ACC) in a newborn baby, whose mother suffered from a recurrent form of maxillary fibrosarcoma and had a burdened obstetric and gynecological history, but was not examined by a geneticist. Complications of ACC in the presented patient were secondary hypertrophic cardiomyopathy with obstruction of the exit paths of both ventricles, Itsenko– Cushing syndrome. Despite the surgical treatment carried out according to vital indications (tumoradinectomy on the right with hormonal support with a Solu-Cortef), the child died during the progression of multiple organ failure and sepsis.

Atherosclerotic cardiovascular disease (ASCVD) remains a significant cause of morbidity and mortality in women, with event rates rising particularly in young women. Women are disproportionately affected by traditional cardiovascular (CV) risk factors such as diabetes and hypertension compared with men. In addition to standard risk factors, many risk factors are either female predominant, such as autoimmune conditions and psychological stressors, or female specific, such as hormonal changes, throughout the course of a lifetime and pregnancy-related issues. Among the most important risk factors specific to women are conditions occurring during pregnancy and history related to fertility and gynecological conditions. The value of such history has become more apparent in recent literature; however, the translation of this knowledge to clinical practice has been poor. The importance of recognizing specific obstetric and gynecological (OB-GYN) conditions and the specific conditions to screen for are the focus of this editorial.

Background. In Russia, adherence to planned highly effective methods of contraception is still at a low level; therefore, emergency contraception (EC) can be the option for protection against unplanned pregnancy.Study design, materials and methods. The current analysis was undertaken to determine the frequency of EC use among women with and without higher medical degree (MD) and to find out the level of awareness about EC among women and men of the same categories. In order to this, the method of anonymous voluntary questioning was used. The questionnaire included items about the theoretical aspects of EC (filled in by both men and women) and data on the gynecological history and experience of EC application (filled in by women only).Results. Half of respondents (49.8%) had experience of EC use, 80% of them used EC only if unprotected sexual intercourse occurred in the middle of the menstrual cycle. Every forth (24.6%, n = 29) obstetrician-gynecologist mistakenly believes that repeated application of EC can lead to infertility. 45% (n = 64) participants without MD and 42% (n = 61) of doctors of other specialties have the same opinion. The use of EC is considered justified by 86% (n = 227) of doctors and 65% (n = 94) participants without MD. Every tenth responder, irrespective of education level, mistakenly believes in not using EC due to severe negative side effects.Conclusion. Almost a third (30%) of obstetrician-gynecologists do not possess complete information on EC. Awareness about EC is extremely inadequate and comparable to that of doctors of other specialties and people without MD. (For citation: Aganezov SS, Morotskaya AV, Aganezova NV. Emergency contraception among doctors and people without higher medical degree. Journal of Obstetrics and Women’s Diseases. 2018;67(4):34-39. doi: 10.17816/JOWD67434-39).

HEART RHYTHM DISTURBANCES IN NEWBORNS IN THE EARLY NEONATAL PERIODGonchar M., Kondratova I., Ivanova Ye., Komova V.Neonatal arrhythmia is not a rare condition, and may occur both in patients with structural heart disease and in children with functional cardiovascular disorders as well as in a relatively small number of healthy newborns. The article presents the results of the study of basic parameters of electrical activity of the heart in newborns with administration of daily ECG monitoring. The study involved examination of 187 infants in the early neonatal period. Assessment of the data of obstetric and gynecological history and extragenital pathology of the mothers of the examined children, analysis of the data of Holter ECG monitoring of newborns showed the most frequently occurring types of neonatal arrhythmias and significant risk factors for their development.Key words: cardiac rhythm disturbances in newborns, neonatal arrhythmias, risk factors. ПОРУШЕННЯ СЕРЦЕВОГО РИТМУ У НОВОНАРОДЖЕНИХ В РАННІЙ НЕОНАТАЛЬНИЙ ПЕРІОДГончарь М., Кондратова І., Іванова Є., Koмoвa В.Аритмії у неонатальному періоді не є рідким явищем та можуть виникати як серед тих, хто має структурні аномалії серця, так і серед дітей з функціональними серцево-судинними розладами, а також у відносно невеликої кількості здорових новонароджених. В статті представлено результати дослідження основних параметрів електричної активності серця у новонароджених за допомогою добового моніторування ЕКГ. Було обстежено 187 немовлят в ранній неонатальний період. За результатами аналізу даних акушерсько-гінекологічного анамнезу та екстрагенітальної патології матерів обстежених дітей, аналізу даних Холтерівського моніторування ЕКГ новонароджених визначено найбільш часто виникаючи види неонатальних аритмій та значущі факторів ризику їх розвитку.Ключові слова: порушення серцевого ритму у новонароджених, неонатальні аритмії, фактори ризику.НАРУШЕНИЯ СЕРДЕЧНОГО РИТМА У НОВОРОЖДЕННЫХ В РАННИЙ НЕОНАТАЛЬНЫЙ ПЕРИОДГончарь М., Кондратова И., Иванова Е., Комова В.Аритмии в неонатальном периоде не является редким явлением и могут возникать как среди новорожденных, которые имеют структурные аномалии сердца, так и среди детей с функциональными сердечно-сосудистыми расстройствами, а также - у небольшого числа здоровых новорожденных. В статье представлены результаты исследования основных параметров электрической активности сердца у новорожденных с помощью суточного мониторирования ЭКГ. Было обследовано 187 новорожденных в ранний неонатальный период. По результатам анализа данных акушерско-гинекологического анамнеза и экстрагенитальной патологии матерей обследованных детей, анализа данных суточного мониторирования ЭКГ новорожденных определены наиболее часто возникающие виды неонатальных аритмий и значимые факторов риска их развития.Ключевые слова: нарушение сердечного ритма у новорожденных, неонатальные аритмии, факторы риска.

Objective: This study aims to evaluate the prevalence of FGM/C among university students in Beni-Suef, Egypt and detect the possible socio-demographic and gynaecological associations. Study design: A cross-sectional study had been conducted on 1723 females attending all faculties of Beni-Suef University (n = 28) and representing all academic years were selected using a multi-stage random sampling to participate in this study. By the beginning of the second term of the academic year 2016/2017, students were interviewed using a questionnaire included questions about the socio-demographic charcteristics, gynecological history, exposure to FGM/C and its justifications, sources of knowledge about FGM/C, gynecological manifestations associated with menstrual flow during the past 12 months and the pain relief methods they used during the same period. Results: Slightly less than half of our students (47.3%) were circumcised. Students residing in rural areas and those with illiterate parents were more likely to experience FGM/C (p

Pathological health of a newborn or a child in the early neonatal period is a manifestation of the complex effects of various factors during pregnancy and childbirth, which require the detailed analysis and are of great scientific and clinical interest. To assess the risk factors and dynamics of clinical manifestations of the consequences of perinatal damage to the nervous system, the somatic health of women, reproductive and gynecological history, features of the course and complications of pregnancy and childbirth were evaluated on the scale of the optimal course of pregnancy and the scale of the optimal course of childbirth. On the basis of this, it is important to build the most sensitive and reliably significant relationships of markers and indices of pregnancy and childbirth in women with different degrees of severity of the consequences of central nervous system perinatal lesions in children.

Objective The objective of this article is to report the first case of intravesical IUD migration at our clinic and raise awareness of forgotten contraceptive devices and their potential complications. Methods We report a case of a 67 year old female who had neglected to remove her IUD for 20 years. She visited our clinic because of recurrent UTI's the previous year. After assessment and clinical investigation it was found that the coil had a late onset migration to the urinary bladder, with calculus formation, causing the patients' symptoms. The encrusted intrauterine device was removed endoscopically after cystolitholapaxy at the operation theatre under anesthesia. Results The patient had an uneventful recovery and her UTI's subsided consequently. Conclusion Recurrent urinary tract infections should trigger further investigation. Gynecological history should be included in this procedure. A history of an unretrieved IUD in a patient with recurrent infections or with chronic pelvic pain and irritative voiding symptoms should raise the suspicion of intravesical migration of the IUD. The management of a migrated IUD is controversial. However, if the IUD is found in the urinary bladder removal is mandatory.

INTRODUCTION: Clinical teaching at outpatient settings is an essential part of undergraduate medical students' training. The increasing number of students in many medical schools and short hospital stays makes inpatient teaching alone insufficient to provide students with the required clinical skills. To make up this shortfall, outpatient clinical teaching has been implemented by our Department of Obstetrics and Gynecology, King Khalid University, KSA, throughout the academic year 2015–2016. The aim of this study was to evaluate the impact of clinical teaching at outpatient settings on the academic performance of our students. MATERIALS AND METHODS: In this comparative retrospective study, the effects of outpatient clinical teaching of obstetrics and gynecology on the academic performance of student was assessed through an objective structured clinical examination (OSCE). During their course on obstetrics and gynecology, 58 students had their clinical teaching both at inpatient and outpatient settings and constituted “study group”. The remaining 52 students had clinical teaching only at inpatient settings and were considered “control group”. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Four stations were used for assessment: obstetric history, gynecological history, obstetric physical examination of pregnant women, and gynecological procedure station. Twenty marks were allocated for each station giving a total score of 80. The OSCE scores for study group were compared with those of the control group using Student's t-test; p < 0.05 was considered statistically significant. RESULTS: The total mean OSCE score was statistically significantly higher in the study group (62.36 vs. 47.94, p < 0.001). The study group participants showed significantly higher scores in the gynecological procedure station (16.74 vs. 11.62, p < 0.0001) and obstetric examination station (16.72 vs. 10.79, p < 0.0001). CONCLUSION: Clinical teaching at outpatient settings leads to an improvement in students' performance in OSCE. There is evidence of remarkable improvement in the mastery of clinical skills as manifested in the students' scores in physical examination and procedures stations. These results will encourage us to have clinical teaching in other disciplines at outpatient settings.

Background So far, multiple factors have been found to be related to the IVF procedure, the most prevalent being extremes of maternal age, infections, previous gynecological history, infertility and others. Although women achieve the coveted pregnancy with the development of IVF technology, the rapid increase contributes to the increase of primary cesarean sections rates. Objective The aim of the study was to identify if the kind of conception affects the kind of cesarean delivery among primiparous women in Greece. Methods This cross-sectional observational study took place from September 2019 to February 2020 at the University Hospital of Larisa in Greece. One hundred and sixty-two primiparous women who underwent a cesarean section (c-section) after IVF (n=27) and natural conception (n=135) participated in the study. Results The mean age of the IVF and natural conception groups were 36.22 and 31.08 years, respectively. Nineteen (70.4%) women of the IVF group had a previous medical or gynecological history in contrast to 48 (35.6%) women of the natural conception group. Only 55.6% of the IVF group had a full-term pregnancy unlike 88.1% of women in the natural conception group. An elective c-section was performed in 18 (66.7%) of the women who conceived after IVF, as opposed to 45 (33.3%) of the women who conceived naturally. Conclusion This cross-sectional study showed that IVF conception was associated with high rates of elective cesarean section as opposed to women with natural conception. The causes of c-sections must be evidence based because the primary cesarean delivery is a major factor contributing to increased c-section rates.

Obtaining a full gynecological history and performing basic examinations and procedures are all important parts of the well-woman visit. It can be difficult for patients to converse and ask questions regarding their sexual health, and having a provider who is able to establish rapport when interviewing and examining patients can allow for a more relaxed and therapeutic environment (Dennerstein et al., Menopause 14(4):688–696, 2007). The use of simulation to help students learn history taking skills as well as proper gynecologic examination techniques will be reviewed. The goal of this chapter is to identify basic gynecologic encounters and procedures where simulation can help learners improve their skills. We will review available trainer options and discuss the use of standardized patients to provide a multifaceted approach to teach what can be delicate interactions and procedures.

Purpose: There are no data regarding the actual need for fertility preservation (FP) in breast cancer (BC) patients. Our study provides a practical needs assessment for reproductive medicine by analyzing an unselected cohort of young BC patients. This assessment considers oncological factors as well as the patient's obstetrical and gynecological history and reproductive outcome after BC diagnosis. We aimed to identify how many patients are actually potential candidates for FP and how many patients might consequently use their cryopreserved gametes to achieve pregnancy. Methods: Based on a prospective BC database, we analyzed all patients who were≤40years at initial diagnosis (time period of diagnosis: 1990-2007; n=100; 7.7% of the entire BC cohort; median age: 35.9years). Results: Using an algorithm of exclusion criteria considering disease-specific, therapy-specific and family history characteristics, 36 patients who received chemotherapy were identified as potential "classical” candidates for FP. After 5years, 22 women were identified as potential candidates for using their cryopreserved gametes to achieve pregnancy; the majority of these patients were childless (n=16, 72.7%) and in their late reproductive years (n=12, 54.5%). Conclusions: Our study demonstrates that in a cohort of young BC patients only a minority of women are candidates for FP. Young BC patients who wish to have children in the future usually carry risk factors both from oncological and reproductive medicine perspective. Due to this high-risk profile, the rarity of BC in young age and the limited number of patients who might actually have opted for FP, these women must be offered timely and multidisciplinary counseling in highly specialized centers

Se comunica 3 casos de cáncer primario de vagina, de rara presentación, diagnosticados y tratados en el servicio de Ginecología del Hospital Edgardo Rebagliati Martins, EsSalud, en el año 2005. Se describe la edad de aparición, antecedente ginecológico, clínica de presentación, localización, histología, estudios de extensión, distribución por estadio, tratamiento y evolución.

Deep infiltrating endometriosis (DIE) of the ileum is an uncommon lesion that may be severe in its clinical presentation. Its diagnosis is challenging in the absence of a gynecological history of endometriosis and because of its anatomical location. We read the article by Sánchez, Candel, and Albarracín, and now report an additional case that was managed urgently.

espanolRESUMEN: Relacion de las infecciones urinarias de repeticion y la fertilidad femenina INTRODUCCION: Las infecciones del tracto urinario (ITU) son patologias que afectan a distintas partes del aparato urinario. La ITU es la segunda causa de infeccion mas frecuente tras la infeccion respiratoria. En la mujer el riesgo de sufrir ITU a lo largo de su vida es superior al 50% y alrededor del 20% sufrira una infeccion urinaria recurrente (ITUR). La presentacion clinica de la ITU durante el embarazo se subdivide en tres categorias principales: Bacteriuria Asintomatica (BA) (2-11%), Cistitis (1,5%) y Pielonefritis aguda (PA) (1-2%). Durante el embarazo los cambios fisiologicos del tracto urinario facilitan el desarrollo de la ITU y aumentan su recurrencia y persistencia. Existe mucha informacion sobre las modificaciones gravidicas en las adaptaciones cardiovascular, pulmonar, metabolica o genital. Interesa conocer los cambios que acontecen en los tejidos blandos, muscular o nervioso del suelo pelvico relacionados con la gestacion. El embarazo y el parto constituyen dos etapas en la vida de la mujer fertil que influyen negativamente en el equilibrio de la estatica y funcionalidad del suelo pelvico. A pesar de la investigacion de las causas de las ITUR, en relacion con el estado estrogenico y la funcion del suelo pelviano, no se conoce la relacion entre los antecedentes obstetricos con la ocurrencia de las ITUR. HIPOTESIS: Podria haber relacion entre la infeccion urinaria de repeticion y los eventos obstetricos y la fertilidad femenina. OBJETIVOS: 1) Conocer la epidemiologia de los antecedentes obstetricos en las mujeres con ITUR. 2) Determinar la relacion de los eventos obstetricos y la presencia de ITUR. Objetivo secundario: Evaluar la relacion entre la distribucion de diagnosticos secundarios mas frecuentes y la presencia de ITUR. MATERIAL Y METODOS: Se realizo un estudio observacional multicentrico y retrospectivo. Se revisaron los historiales clinicos de 714 mujeres: Grupo A (n= 588): pacientes estudiadas y tratadas por ITUR y Grupo B – grupo control (n= 126): pacientes tratadas, mediante nefrectomia, por cancer de rinon. Se analizan los resultados con estadistica descriptiva, t de Student, Chi2, test exacto de Fisher, analisis de la varianza ANOVA (con test de Scheffe's para muestras normales y Kruskal Wallis para otras distribuciones), estudios de correlacion de Pearson y Spearman. Se acepto una significacion estadistica para p RESULTADOS: El grupo control (mujeres sin ITUR) presenta: Hipertension arterial (HTA) en todos los antecedentes obstetricos estudiados, la mayoria de los grupos presentan mas dislipemia y obesidad. Cuando hay histerectomia sin anexectomia, la Diabetes Mellitus (DM) es mas frecuente en el grupo control. El grupo de estudio (mujeres con ITUR): Tienen menos diagnosticos secundarios, estan sanas por lo general. En cuanto a la DM, tiene mayor peso en la asociacion con ITUR en las mujeres nuliparas, mientras que no tiene peso en las mujeres con antecedentes obstetricos. Por tanto, la DM es un factor importante en el antecedente de nuliparidad, mientras que los antecedentes obstetricos igualan su distribucion. CONCLUSIONES: En las mujeres diagnosticadas de ITUR, encontramos que el 3.4% son nuliparas, 70.74% tienen antecedentes de partos eutocicos, 9.86% de partos distocicos, 17.34% han sido operadas de legrado por aborto, 17% han sido intervenidas de histerectomia sin anexectomia y 17% de histerectomia con anexectomia bilateral. El antecedente de nuliparidad se asocia mas al grupo control, mientras que la historia de partos eutocicos se asocia con el grupo experimental con ITUR. El antecedente de parto distocico se asocia a un peor estado de salud respecto al resto de antecedentes en relacion con la comparacion de mujeres con y sin ITUR, siendo en este grupo el diagnostico secundario de suelo pelviano mas frecuente la incontinencia urinaria (IU). La interrelacion entre los antecedentes obstetricos y la presencia de DM en mujeres con ITUR no asocia correlacion positiva, salvo en las mujeres nuliparas donde la DM condiciona por si misma el aumento de la ITUR. La DM en si misma es un factor de riesgo de ITUR mas potente que los antecedentes obstetricos/ginecologicos. Los antecedentes ginecologicos/obstetricos mas prevalentes en las mujeres con ITUR son el parto eutocico asociado a un buen estado de salud. En las mujeres con un estado de salud mas deteriorado, el antecedente que se asocia a ITUR es el parto distocico, siendo mucho mas prevalente la IU concomitante. EnglishABSTRACT: Relationship between Urinary Tract Infection and female fertility. INTRODUCTION: The Urinary Tract Infections (UTI) are a group of pathologies affecting the different parts of the urinary system. UTI is the second most frequent cause of infection after respiratory infection. In women, the risk of suffering UTI is over 50% during their life and about 20% will suffer a Urinary Tract Recurrent Infection (UTRI). The clinical profile of UTI during pregnancy is subdivided into three main categories: Asymptomatic Bacteriuria (2-11%), Cystitis (1.5%) and Acute Pyelonephritis (AP) (1-2%). The physiological changes involving the urinary tract during pregnancy, facilitate the development of UTI and increase its recurrence and persistence. There is a lot of information about gravidic modifications in the adaptation of the cardiovascular, pulmonary, metabolic and genital systems. It is of interest to know the changes that occur in the soft, muscular or nervous tissues of the pelvic floor related to gestation. Pregnancy and delivery are two stages in a fertile woman’s life which have a negative influence in the static and functionality of the pelvic floor. Despite the investigation of the UTRI causes related to the estrogenic state and the pelvic floor function, the relationship between the obstetric history and the occurrence of the UTRI is not known. HYPOTHESIS: There could be a relationship between the UTRI and the obstetric events and female fertility. OBJECTIVES: 1) Know the epidemiology of the obstetric history in women with UTRI. 2) Determine the relationship between the obstetric events and the presence of UTRI. Secondary aim: to evaluate the relationship between the distribution of most frequent secondary diagnoses and the presence of UTRI. MATERIAL AND METHODS: A retrospective multicentric study reviewing the clinical history of 714 patients was carried out: Case group A (n=588): patients studied and treated by UTRI and Group B - control group (n=126): patients treated, by nephrectomy, for kidney cancer. The results were analyzed with descriptive statistics, student’s t test, chi2 test, Fisher’s exact test, ANOVA analysis of variance (Scheffe’s test for normal sample and Kruskal Wallis for other distributions), Pearson and Spearman correlation studies. A significance level of p-value RESULTS: The control group (women without UTRI) presented: Arterial Hypertension in all the obstetrics history studied, most of the groups presented more dyslipemia and obesity. When there is hysterectomy with adnexectomy Diabetes mellitus (DM) is more frequent in the control group. In the case group (women with UTRI): patients have less secondary diagnoses, they are generally healthy women. Regarding DM, it has greater weight in the association with UTRI in nulliparous women, while it has no weight in women with obstetric history. Therefore, the DM is an important factor in the nulliparity while the obstetric history equals its distribution. CONCLUSIONS: Among women diagnosed of UTRI we found 3.4% are nulliparous, 70.74% have a history of eutocic deliveries, 9.86% have a history of dystocic deliveries, 17.34% have undergone surgery for abortion, 17% have undergone hysterectomy without adnexectomy and 17% hysterectomy with bilateral adnexectomy. The antecedent of nulliparity is associated more to the control group, while the clinical history of eutocic delivery is associated with the case group, women with UTRI. The antecedent of dystocic birth was associated with a worse state of health compared to the other antecedents in relation to women with and without UTRI, being in this group the most frequent secondary diagnosis of pelvic floor, Urinary Incontinence (UI). The interrelation between the obstetric antecedents and the presence of DM in women with UTRI does not associate positive correlation, except in nulliparous women where the DM determines by itself the increase of UTRI. DM itself is a more powerful risk factor for UTRI than the obstetric / gynecological history. The most prevalent gynecological / obstetric history in women with UTRI is the eutocic birth associated with a good state of health. In women with a more deteriorated state of health the antecedent associated with UTRI is dystocic delivery, the concomitant UI is much more prevalent.

Introduction: Menstrual disorders are the most frequent gynecological diagnoses among young girls. Aim: This study was conducted to investigate whether physical activity could reduce menstrual disorders among schoolgirls. Methods: In this cross-sectional study, 970 schoolgirls in Southern Egypt were assessed, using a questionnaire, for their socio-demographic characteristics, gynecological history, physical activity, and menstruаl disorders during the previous 6 months. Results: The mean аge of schoolgirls was 15.5 ± 0.8 yeаrs, menarche аge 13.2 ± 1.2 years, menstrual cycle durаtion 28.8 ± 7.3 dаys, and 76.1% were circumcised. After аdjustment for the socio-demographic and gynecological variables, physical activity wаs shown to be not associated with all premenstrual symptoms аnd dysmenorrheа (р -value > 0.05). Conclusion: No substantial associаtions between physical activities and menstruаl/premenstrualal symptoms can be concluded. Recommendations: Future cohort and interventional studies are needed to explain whether the risk of dysmenorrhea and premenstrual symptoms can be reduced by physical activity.

Se reporta un caso de melanoma de vagina, de rara presentación, diagnosticado y tratado en el servicio de Ginecología del Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Se describe la edad de aparición, antecedente ginecológico, clínica, localización, histología, estudios de extensión, tratamiento y evolución.

РЕЗЮМЕ. З метою підвищення ефективності діагностики гіперпластичних процесів ендометрія у жінок перименопаузального віку було проведено ретроспективний аналіз 52 карт стаціонарного хворого жінок, які перебували на лікуванні в гінекологічних відділеннях Тернополя і області. У відповідності з патогістологічним висновком, 1 групу склали 28 жінок з простою іперплазією ендометрія, 2 групу – 24 жінки з комплексною гіперплазією ендометрія. У групу порівняння ввійшли 12 соматично здорових жінок. Пересічний вік хворих 1 групи становив (47,0±1,0) років, 2 групи – 56,0±1,5) років. З метою поглибленого аналізу показників застосовано багатопараметричну нейромережеву кластеризацію. Встановлено, що до факторів ризику розвитку гіперпластичних процесів ендометрія у жінок ерименопаузального періоду належать неблагополучні соціально-економічні фактори: проживання в сільській місцевості, тяжкі умови праці, шкідливі звички та обтяжений акушерсько-гінекологічний анамнез, 3 і більше агітностей, велика кількість (4 і більше) акушерсько-гінекологічних втручань, використання внутрішньоматкової контрацепції. З метою встановлення значення поєднаних змін тих чи інших параметрів для прогнозу прогресування захворювання здійснено нейромережеву кластеризацію. становлено, що ймовірність прогресування гіперпластичних процесів ендометрія зростає з віком, якщо це поєднується із збільшенням кількості лейкоцитів у периферійній крові.

Репродуктивне здоров’я жінок є важливою складовою становлення позитивної демографічної ситуації в країні та створення передумов для приросту населення. У статті висвітлені дані літератури про стан репродуктивного здоров’я жінок, проведено його статистичний аналіз у жінок Херсонської області та акцентовано увагу на несприятливих перинатальних наслідках, що виникають у результаті обтяженого акушерського та гінекологічного анамнезу.

Aim: To review the quality of prenatal care data registered by the professionals from the Family Health Strategy (ESF) in Jericoacoara city – Ceara State – Brazil. Methods: This was a quantitative and documental study,in which were analyzed 71 obstetric records of pregnant women who underwent prenatal care in 2006. The studied variables comprised those obtained by data quality review of standard obstetric records regarding to socioeconomic aspects, family history, personal and obstetric and the data related to current pregnancy. Results: Among the 71 obstetric records reviewed, in 70 of them (98.6%), the socioeconomic data were completed satisfactorily. The data concerning the history of familiar and personal morbidity, besides obstetric and gynecological history of the pregnant women were 100% (71) complete. Referring to the data of current pregnancy collected during the anamnesis of the first medical appointment, it was detected that 47 (66.2%) were filled in properly, while in 24 (33.8%) of them there were missing important data, such as height and weight of the pregnant women. From all obstetric records, in only 60 (84.5%) there were the registers of all laboratory tests compulsory for the first trimester of pregnancy and it’s highlighted that only 43 (60.6%) of the records were filled in properly regarding the lab tests of the third trimester. It was yet verified that in only 6 (8.5%) of the records there was information related to the curve of uterine height/gestational age. Conclusion: In this study, the adequate filling of obstetric records was observed, although we found a great number oflack or ofincomplete registers in the topic related to the graphs of height/weight and the curve of uterine height/ gestational age

Background: Cervical erosion is one of the most common pathological conditions encountered in outpatient gynecological clinics in middle-aged women. A simple method for diagnosis and treatment can play a tremendous role to comfort these women. Methods: The study includes fifty female patients attended the outpatient clinic of obstetrics & gynecology department in Mansoura University hospitals. All patients selected according to inclusion and exclusion criteria. The study was undertaken during the period from June 2014 to December 2014. Tools: Two tools were used for data collection: (1) Interviewing questionnaire schedule divided into three parts which were used to assess general characteristics of women, obstetric and gynecological history and the presence of cervical ectopy symptoms. (2) Local cervical assessment by vinegar acetic acid (VIA) test. Results: The study results revealed that 30 subjects (60%) were VIA positive and 20 subjects (40%) were VIA negative. VIA sensitivity was 100%, specificity 45%, PPV 71% and NPV 75%. There was a statistically significant relation between duration of marriage, high parity, IUDs use and VIA positivity. Conclusions: Using VIA test was an accurate and effective method for detection of cervical ectopy. VIA test should be performed in all the women attending outpatient gynecological clinics even in the presence of Pap smear facility to improve detection rate of cervical lesions and provide better patient counseling and treatment.

Резюме . З метою підвищення ефективності діагностики гіперпластичних процесів ендометрія у жінокперименопаузального віку було проведено ретроспективний аналіз 52 карт стаціонарного хворого жінок, якіперебували на лікуванні в гінекологічних відділеннях Тернополя і області. У відповідності з патогістологічнимвисновком 1 групу склали 28 жінок з простою гіперплазією ендометрія, 2 групу – 24 жінки з комплексною гіперплазієюендометрія. В групу порівняння увійшли 12 соматично здорових жінок. Середній вік хворих 1 групи – (47,0±1,0)років, 2 групи – (56,0±1,5) років. З метою поглибленого аналізу показників застосовано багатопараметричнунейромережеву кластеризацію. Встановлено, що до факторів ризику розвитку гіперпластичних процесівендометрія у жінок перименопаузального періоду належать неблагополучні соціально-економічні фактори:проживання в сільській місцевості, тяжкі умови праці, шкідливі звички та обтяжений акушерсько-гінекологічнийанамнез, 3 і більше вагітностей, велика кількість (4 і більше) акушерсько-гінекологічних втручань, використаннявнутрішньоматкової контрацепції. У жінок з різними видами гіперплазії ендометрія клімактеричний синдромперебігав середньотяжко чи тяжко з нейровегатативними, ендокринно-обмінними та психоемоційними проявами.Серед коморбідних станів найчастіше спостерігали дисгормональну патологію молочних залоз та порушеннягепатобіліарного тракту.Ключові слова : гіперпластичні процеси ендометрія, клімактеричний синдром, перименопаузальний вік,дисфункційні маткові кровотечі, коморбідні стани, нейромережева кластеризація.

A 26-year-old woman with a complicated urological and gynecological history with uterine didelphys with bilaterally inserting intravesical cervical oses presented with cyclical haematuria. Work up revealed a mass in the ectopic cervical os and adjacent bladder wall. Subsequent resection confirmed a clear cell adenocarcinoma of urological origin with invasion into neighbouring os.

Maternal morbidity is a concept of increasing interest in maternal health. This review aims to assess the contributory factors for severe maternal morbidity over the past one decade worldwide. A comprehensive electronic search was conducted. The search was restricted to articles written in the English language published from 2004 to 2013. Qualitative studies were excluded. A total of 24 full articles were retrieved of which 9 cohort, 7 case–control, 3 cross-sectional studies, and 5 unmentioned designs were included. The contributory factors were divided into 3 components: ( a) sociodemographic characteristics, ( b) medical and gynecological history, and ( c) past and present obstetric performance. This review informs emerging knowledge regarding contributory factors for severe maternal morbidity and has implications for education, clinical practice and intervention. It enables a better understanding of the problem and serves as a foundation for the development of an effective preventive strategy for maternal morbidity and mortality.

Lack of adherence to therapy is a common problem in the treatment of various diseases and conditions and there are many well documented reasons for it. Although patients are generally motivated to adhere to therapy by their concern regarding the disease itself, possible side effects may also worry the patient, resulting in reluctance to follow the treatment plan. The patients’ adherence to HRT was shown to be dependent on the specialisation/position of the physician who initially recommended it, the adherence rate being highest at private gynaecologists' and university clinics and lowest at general practice and community health centres. Adherence to HRT in Croatia was found to be exceptionally low. This study was conducted to assess the effect of time spent on medical consultation in relation to the duration of adherence, as well as the reasons to adhere to or drop out from HRT. Two methods were used, self-filled questionnaires on a sample of patients and telephone interviews on a sample of doctors. The patient questionnaires were administered and collected at the Ob/Gyn and GP offices. The questions dealt with a number of personal and gynaecological history variables, including use of HRT, origination of HRT recommendation, attitudes in favour and against HRT, and total duration of HRT. A total of 40 participating offices submitted 1, 263 patient questionnaires for analysis. The doctors' attitudes and time spent on consultation were assessed using telephone interviews on a sample of 90 gynaecologists employed by clinical hospitals, health community centres and private practices. The doctors were interviewed regarding the average time spent with a patient, dilemmas in prescribing HRT and counselling on sexuality issues. The main finding was that the time spent on consultation and the physicians' interest in postmenopause critically influence the patients' adherence. The effective time spent with patients was in accordance with the National Health Insurance guidelines for public sector doctors, but it was twice as long for private sector doctors, who can also boast of the highest adherence rates. This study shows that extended medical consultation promotes better compliance through lowering patient fears, while trusted authorities seem to be more convincing to patients on the benefits of HRT and therefore more effective, even if not taking more time to talk to patients.

Isolated abdominal wall actinomycosis in the presence of an intrauterine contraceptive device (IUCD) is extremely rare and only six such cases have been reported in the literature. We report a case where clinical and radiological examinations revealed a pseudotumor within the anterior abdominal wall. After being lost to follow-up, the patient presented two years later with the enlargement of the mass. The mass including the affected anterior abdominal wall was completely excised. The diagnosis of actinomycosis was established postoperatively by histopathological examination. Further questioning concerning her gynecological history revealed long-term use of the same IUCD. Surgical excision of the actinomycotic pseudotumour and removal of the IUCD followed by antibiotic therapy resulted in the full recovery of the patient.

To describe human papillomavirus (HPV) vaccine uptake, predictors of vaccination, and barriers to vaccination in young women.Participants were 13-26-year-old girls and women recruited from an urban, hospital-based clinic. Between June and December 2007, 6 months after they had completed a baseline survey, they were recontacted to assess receipt of at least one HPV vaccine dose and barriers to receiving the vaccine. We assessed whether demographic factors, gynecological history, and attitudes measured at baseline were associated with vaccination at follow-up using logistic regression.Of the 262 women who completed the baseline study, 189 (72%) participated in this follow-up study. At follow-up, 68 of 189 (36%) had receivedor=1 HPV vaccine dose. Factors measured at baseline that predicted vaccination 6 months later included insurance coverage for HPV vaccination (odds ratio [OR] 5.31, 95% confidence interval [CI] 1.61-17.49) and the belief that one's parents, partners, and clinicians endorsed HPV vaccination (OR 2.21, 95% CI 1.29-3.79); those with a history of an abnormal Pap test were less likely to have received the vaccine (OR 0.30, CI 0.10-0.92). Of the 121 who were unvaccinated, 54 (45%) had not returned to the clinic since the baseline study, 51 (42%) had returned but were not offered vaccine, and 15 (12%) had declined vaccination.Interventions to increase HPV vaccination rates in women in the catch-up age group for vaccination should ensure that vaccine costs are covered, promote HPV vaccination as normative, and establish clinic-based systems to prevent missed opportunities for vaccination.

This paper is based onfour publications on a populntion-based case-contol study in I I cities in Indonesia in 1989/1990 to assess the rtsk of ectopic pregnancy (EP) associated with gyneco confrmed. Each case was matched by one pregna pre7nant controls, current I(JD use decreased the p IUD use for > 3 years increased the probabilities [adjusted odds ra with pregrni controls, history of pr)vious EP, indrcid abortion, miscarriage, pelvic inflanwatory disease, smoking habit, ana cunent IUD ur" jo, i y"o^ o, *o* in r"i"eâ 715k of ectopic nidation. The strongest riskfactor was previous EP (adjusted OR = 16.8: 95Io CI: 2' I-132'5)

[no abstract available]

A good history is the key to any diagnosis. Compilation of symptoms in a correct sequence may provide the diagnosis even without examination. In other instances, the symptoms considered in relation to lesions found on pelvic examination will provide the diagnosis in cases where history or physical examinations alone had been inconclusive.

The necessity of hormone replacement therapy (HRT) remains a controversial subject, but guidelines suggest that the subject be discussed with all menopausal women.To determine the rate of HRT use among women cared for in family-practice, university-affiliated teaching clinics.Physicians from six family-practice teaching clinics enrolled all menopausal patients, aged between 50 and 70 years, registered in their practice. A detailed questionnaire was completed regarding demographic and health variables, gynecological history and the nature of HRT use.In total, 682 women were invited to participate in the study; 587 (86%) participated. Some 74% of the women were married, 64% were secular and 43% stated that they performed regular exercise. Current HRT use was reported by 156 women (26.6%). Most women (83%) had been treated for over 1 year. Common indications for starting treatment were hot flushes (75%), and routine recommendation by their physician (68%). Eighty-three (14%) women were past HRT users. It was stated by 45% of never-users that HRT had never been offered to them. Current users of HRT were found to be younger than non-users (mean age 58.2 years vs. 61.5 years, p0.0001), more secular than traditional or religious (p0.0001) with more years of formal education (p0.0001), and more likely to be of Western or European ("Ashkenazi") origin (p0.0001). Current HRT users reported fewer chronic illnesses than did non-users (p = 0.001); they were more likely to report being engaged in regular exercise (p0.002) and were less likely to be obese (p0.005). In a multiple regression model, HRT use was associated with more years of formal education and a secular identity.Our study found a higher proportion of women using HRT than in other Israeli studies. HRT use was more prevalent among women with improved health status and higher socioeconomic status. The most common reason given for not using HRT was that a physician had not raised the subject, indicating that physician-related factors might contribute to using HRT. Thus, comparing HRT prescribing rates in non-teaching clinics should clarify this factor.

Two hundred ninety-nine female adolescent patients ages 11-22 at three Los Angeles area clinics were studied to determine the relationship between knowledge of their bodies, gynecological history, self-esteem and attitude toward the pelvic exam. The population was 75% black, 16% hispanic, 7% white. Patients came from medical, family planning or teen prenatal clinics. The Texas Social Behavior Inventory was used as a measure of self-esteem. A positive attitude toward pelvic exams was associated with higher levels of both knowledge (p = .0003) and self-esteem (p = .039). However, a small group emerged with high self-esteem and good knowledge who nevertheless had a poor attitude toward pelvic exams. The origin of this paradox is unclear. Physician and parent explanations about the pelvic exam produced significantly better knowledge scores (paired T-test p < .05) than explanations by other health professionals or friends. High knowledge scores were significantly associated with tampon use, contraceptive usage or receipt of health education.