[Development and practical implementation of organ preservation surgery in case of placenta accreta in patients with a scar on the uterus].

Comparative analysis of methods for preventing/stopping intraoperative hemorrhage during surgical delivery of patients with placenta accreta (temporary balloon-assisted occlusion of common iliac arteries, internal iliac artery ligation; uterine artery embolization - UAE) has shown that internal iliac artery ligation is not effective. UAE and especially balloon-assisted occlusion of common iliac arteries have demonstrated a significantly greater effect due to the temporary 'devascularization' of the uterine corpus. It has been proved that an innovative surgical technique - a lower segment Caesarean section (LSCS) significantly reduces intraoperative blood loss. The main purpose of an alternative uterus cut - anterior placenta previa preserving and bleeding absence before the child removal - has been achieved within all observations. LSCS has caused a significantly smaller (by 1.6 times) amount of intraoperative blood loss than the corporal one. Another innovative surgical technique is metroplasty. It entails removing placenta accreta areas from the uterus with subsequent restoration of the organ integrity. The authors have proved the necessity of autologous advance blood donation and hemodilution strategy, which was first implemented in Moscow Center for Family Planning and Reproduction, and after 2006 was used in all obstetric institutions in Moscow. This allowed reducing the number of blood donations up to 85% and additionally decreased transfusiological risks which is economically valuable as well. Improvement of diagnostic methods, operating techniques, hemostasis, blood volume redistribution and creating an algorithm on its basis has proved the possibility of implementing an organ-, life, health- and fertility preserving approach in cases of placenta accreta in patients with a scar on the uterus after cesarean section. The introduction of the enhanced principles of patient management with placenta accreta has significantly reduced the number of hysterectomies in Moscow (from 48 in 2007 to 8 in 2016), and during the last 2 years no patient with this complication has had a hysterectomy. 12 out of 85 patients who had deliveries in accordance with the developed algorithm, have realized their subsequent fertility.

[Prognostic value of uteroplacental circulation impairment in 1st trimester of pregnancy in patients with complicated obstetric history].

UNLABELLED: One of the urgent problems of modern obstetrics is the early detection of irregularities in the development of the uteroplacental vessels system in patients with severe disorders in the history. AIM: To evaluate the predictive value of re-development of obstetric pathology on the basis of the uterine artery Doppler on 11-14 weeks of pregnancy. PATIENTS AND METHODS: 410 patients in I trimester of pregnancy were examined with fetal growth restriction, preeclampsia and/or fetal death and/or a history of preterm delivery were. The influence of physical factors and obstetric history on the state of uterine blood flow in the I trimester of pregnancy was studied. RESULTS: The optimal Doppler indexes was calculated; a high predictive ability of the pulsation index in the uterine arteries with respect to pregnancy complications with early clinical manifestation, severe preeclampsia and combined obstetric complications was detected. CONCLUSIONS: Our data support the possibility of preclinical diagnosis of obstetrical complications in patients with complicated obstetric history.

[The effect of hypoxia on the urokinase and adenylate cyclase systems in the culture of endothelial cells of the human umbilical vein].

Hypoxia induces angiogenesis in ischemized tissues by means of pro-angiogenic factor expression. The key role in the growth processes and blood vessel functioning belongs to the matrix metalloproteinases, plasminogen, and its activator systems. Effect of hypoxia on expression of the urokinase activating agent plasminogen and its receptor in endothelium was studied in human umbilical vein endothelial cell model. Incubation of the endothelial cells under the conditions of hypoxia proved to reduce both urokinase formation in these cells and its secreting into the culture medium. The hypoxia-induced reduction of urokinase contents was accompanied by enhancement of expression of the urokinase receptor. The hypoxia also entailed reduction of the adenylate cyclase activity and cAMP contents in the endothelial cells. The data obtained suggest that reduction of the adenylate cyclase activity and cAMP contents under the conditions of hypoxia provide basis for suppression of the urokinase expression by the endothelial cells and, consequently, inhibition of blood vessel formation in the ischemized tissue.

[Hemosorption in the prevention of severe forms of hemolytic disease of the newborn in rhesus sensitization]. / Gemosorbtsiia v profilaktike tiazhelykh form gemoliticheskoi bolezni novorozhdennogo pri rezus-sensibilizatsii.

A total of 164 hemoperfusions were administered to 60 pregnant patients with Rh sensitization and a history of perinatal death of the newborns from hemolytic disease. Hemoperfusion was found to decelerate the progress of hemolytic disease of the newborns promoting delivery of babies with more benign forms of the disease. The method efficacy was 76%. Dynamic follow-up of fetal functional status over the course of hemosorption treatment by examinations of biophysical profiles and ultrasonic dopplerometry has shown no negative effects of this treatment modality on fetal status.

[Ultrasonic placentometry in pregnancy]. / U'ltrazvukovaia platsentometriia vo vremia beremennosti.

The authors developed mathematical formulas for the determination of the size of the placenta during the pregnancy based on the technique of ultrasonic scanning. Healthy pregnant females with 19-40 weeks of gestation underwent ultrasonic placentometry. Reference placental volumes were defined. The authors demonstrated an increment in the placental volume and its growth rate with evolving pregnancy.