[Surgical treatment of a pregnant female with AVM hemorrhage]. / Khirurgicheskoe lechenie patsientki s krovoizliyaniem iz AVM vo vremya beremennosti.

Hemorrhages from arteriovenous malformations (AVMs) in pregnant females are rare, but they are known to lead to high maternal and infant mortality. There are no standards for AVM treatment in pregnant females. Many authors believe that AVM resection before delivery improves the prognosis for life and health of the mother and fetus. In this paper, we present a case of successful surgical treatment of a female patient with AVM hemorrhage at 20 weeks and address management issues of these patients.

[Spinal stroke in a pregnant female with an endodermal cyst of the cervical spinal cord (a case report and literature review)]. / Ostroe narushenie spinal'nogo krovoobrashcheniya u beremennoi s endodermal'noi kistoi sheinogo otdela spinnogo mozga (sluchai iz praktiki i obzor literatury).

AIM: The study purpose was to present a clinical case of spinal stroke in a pregnant female, which was caused by an endodermal cyst of the cervical spinal cord, and to analyze treatment tactics. RESULTS: A 20 week pregnant female presented with acute transverse spinal cord injury at the of C3-C5 spinal segment level. CT revealed an extramedullary space-occupying lesion in the ventrolateral position, with compression of the spinal cord at this level. The patient in the state of progressive deterioration with respiratory failure was transferred to the Neurosurgical Institute on the 5th day after disease onset. The patient underwent surgery on the 7th day after disease onset. Doctors of various specialties participated in preparation for surgery. During surgery, total resection of the space-occupying lesion and spinal cord decompression were performed. An obstetrician-gynecologist conducted intraoperative fetal monitoring by ultrasound. The histological diagnosis was an endodermal cyst. There was no improvement of neurological symptoms in the early postoperative period. After stabilization of the condition, the patient was discharged for follow-up care at the place of residence. According to the follow-up report, the patient underwent the cesarean section because of exacerbation of lung infection and a significant delay in the fetal development. After a few days, the patient died due to multiple organ failure. The child was alive, in serious condition, under mechanical ventilation. CONCLUSION: In the case of spinal stroke, the decision on treatment tactics should be made no later than 12 hours after its onset; otherwise, the outcome is usually unfavorable, and a neurological deficit is irreversible. The decision about continuing pregnancy should be made individually in each case, and an approach to the choice of appropriate treatment tactics should be multi-disciplinary.

[The specific features of delivery in women with gestosis and myopia].

The treatment option for retinal degeneration, including peripheral vitreochorioretinal degenerations, was performed in 415 pregnant females (including 25 healthy pregnant females); it differed in patients with myopia and gestosis at labor and in the postpartum period in the fact that regularity was first revealed at labor: increases in cardiac output and cerebral circulation index and a decrease in uveal tract blood filling (rheographic quotient, Rq) from 1.78 to 0.5-0.7 per thousand. This results in retinal tissue hypoxia and dystrophy to give rise to free radical oxidation products. The treatment is that vasodilators increasing uveal tract blood filling by 0.9 per thousand are intravenously injected. Prolonged epidural anesthesia used during administrations of spasmolytics and vasodilators additionally shows a 0.9 per thousand increase in Rq in parturients with myopia and gestosis. Antioxidants that inhibit free radical oxidation products are used in the lipoprotein complexes of retinal cells and retinal degeneration are prevented and treated.

[Optimization of anesthesiological management of the delivery in women with moderate and high myopia]. / Optimizatsiia anesteziologicheskogo obespecheniia rodorazresheniia u patsientok s miopiei srednei i vysokoi stepeni.

Eye fundus, functional state of retina, intraocular pressure, central hemodynamics and cerebral circulation were examined in 290 patients with moderate or severe myopia and in 25 healthy women during pregnancy, in parturition period and after labors. 255 labors were conducted by way of natural maternal passages under prolonged epidural anesthesia at the first and second stages of labor. Epidural anesthesia was accompanied by decreasing vasoconstriction and both cerebral and ocular circulation improvement. There was no any progress in myopia in a year after delivery. The labor by way of normal maternal passages were proved to be carried out under epidural anesthesia in patient with moderate and severe myopia.