[Early neonatal mortality in the Russian Federation in 2010].

The paper analyzes the data of the Federal State Statistics Service on early neonatal mortality in the Russian Federation as a whole and its federal districts in 2010. There was a steady decline (ranging from 6.52 to 2.75%) in the mean early neonatal mortality rates in the Russian Federation in 2000-2010. In 2010, there were low, moderate, and high early neonatal mortality rates in 59 (71.1%), 20 (24.1%), 4 (4.8%) federal subjects, respectively. Most neonatal deaths were noted within the first 24 hours of life. According to the Federal State Statistics Service data, the commonest cause of early neonatal death in Russia is respiratory distress (103.2 deaths per 100,000 live births), hyaline membrane disease in particular. Among the causes of neonatal death, maternal diseases unrelated to pregnancy are indicated most commonly (in 22.7% of cases).

[Stillbirth rates in the subjects of the Russian Federation in 2010].

The paper analyzes the 2010 Russian State Statistics Service data on stillbirth rates in the Russian Federation and its subjects. There was a steady decline in the mean stillbirth rate (from 6.8 to 4.67 per thousand) in the Russian Federation in 2000-2010. In 2010, the rate was low in 10 (12%) subjects, moderate in 42 (50.6%), and high in 31 (37.4%). The reduction in the proportion of intranatal stillbirth is naturally accompanied by the increase in its antenatal component. According to the data of the Russian State Statistics Service, the most common cause of stillbirth is intrauterine hypoxia and birth asphyxia: 391.9 per 100,000 born alive and dead. The most frequent maternal cause was notified to be placental pathology: 209 per 100,000 born alive and dead.

[A new approach to treatment of the intraabdominal hypertension syndrome in patients with diffuse peritonitis].

Results of treatment of 49 patients with diffuse purulent peritonitis were analyzed. The patients were divided into two statistically similar groups. The control group of patients consisted of 27 patients treated using traditional methods. Patients of the main group (22) were treated by the same method, but the defect of the abdominal wall was closed using wide-meshed reticular polypropylene endoprosthesis with total size of the meshes not less than 70% of the general square surface. During every programmed sanation the prosthesis was cut longitudinally along the whole length and sutured so that the level of intraabdominal pressure was not more that 15 mm Hg. In the nearest postoperative period the main group patients had endotoxicosis 1.3 less, and the motor-evacuatory function of the intestine was 2.2 times higher which resulted in 1.3 times less postoperative lethality. In the long-term postoperative period excellent results of treatment became 13.3% more often, good results were 12.7% as compared with the control group.

[Immobilized forms of sodium hypochlorite in carboxymetilcellulose gel used in treatment of disseminated peritonitis].

56 patients with disseminated purulent peritonitis were observed. All patients were divided into 2 groups. 30 patients treated according to traditional technique formed the first group. Surgical treatment included: laparotomy, elimination of the underlying condition that caused peritonitis, nasointestinal intubation of small intestine, abdominal cavity sanation with 0.02% furacillin solution till pure liquid, drainage. 200 ml of 0.03% aqueous solution of sodium hypochlorite was infused into abdominal cavity before closure. 26 patients treated according to the similar technique formed the second group. In contrast to the first group, 200 ml of immobilized form of sodium hypochlorite in carboxymetilcellulose gel was infused to the patients from the second group before wound closure. In early postoperative period the indices of endotoxicosis were in 1.6 times lower in patients from the second group and motor-evacuatory function of the stomach--twice higher compared with the patients from the first group. It decreased the amount of complications in 2 times, and postoperative lethality--in 2.6 times. In long-term postoperative period perfect treatment results increased in 20.8%, well--in 4.1%, tolerable--decreased in 20.9% compared with the results in the control group.

[Decision on the method of surgical intervention for diffuse purulent peritonitis].

An analysis of complex examination and following treatment of 245 patients with diffuse purulent peritonitis has shown that the traditional (semi-closed) method of treatment should be used in patients with symptoms of abdominal sepsis. Programmed video-laparoscopies are indicated to patients with symptoms of abdominal sepsis with/without mono-organic insufficiency. Staged surgical sanations of the abdominal cavity are indicated to patients with severe abdominal sepsis with poly-organic insufficiency.

[Experimental-clinical grounds of the application of immobilized forms of sodium hypochlorite in treatment of diffuse peritonitis].

Experimental (200 experiments) and clinical (in 46 patients) investigations have shown that immobilized forms of sodium hypocloride in methylcellulose gel makes the lethality level 1.9 times lower and the formation of abdominal adhesions 1.8 times less in experimental peritonitis. In patients with diffuse peritonitis this form restores the propulsive ability of the intestinal tube 2 times quicker and makes lethality 2.7 times less.

[Medical and social aspects of the protection of working women's health]. / Meditsinskie i sotsial'nye voprosy okhrany zdorov'ia rabotaiushchikh zhenshchin.

The paper presents statistic data on the Russian females engaged in national economy and its individual industries, results of studies into the reproductive health of working women (their health during pregnancy and nonpregnancy, gynecological morbidity). It also gives data on the relationship of reproductive health with the factors of production.

[Problems for discussion on contraception for women after childbirth]. / Diskussionnye voprosy kontratseptsii u zhenshchin posle rodov.

PIP: Questionnaires were administered to 300 postpartum women in 3 delivery wards in Moscow to determine their opinions about contraceptives. Similarly, 100 gynecologists-obstetricians were queried in 2 wards, at 2 counseling sites for women, and at regional seminars of gynecologists-obstetricians. 52% of the physicians recommended the condom to nursing mothers whenever sexual activity was resumed and the IUD from the 3rd and 4th month on. 60% of the doctors thought that women who were not breast feeding could similarly start using the condom and from the 3rd and 4th month either the IUD (82%) or oral contraceptives (36%). 71.1% of the women were under 30 years of age, and were relatively well educated. 68% of them had their first birth, 28.3% had their second, only 3.7% had their third or higher order of births. 35% of the women did not plan the present pregnancy. 81% of the women were using contraception up to the time of the present pregnancy, and the most popular methods were coitus interruptus (36.3%), the rhythm method (35.3%), the condom (28.3%), the IUD (13%), and hormonal methods (10.6%). Although 46.3% of the women preferred the IUD after birth, only 7.3% of them preferred hormonal preparations. In this study 71.5% of the mothers were breast feeding their infants. 13.5% of the women had gestosis in the 2nd half of the pregnancy, 5.8% had anemia, and 21.3% experienced the threat of miscarriage. In 12.9% of the cases there were other pathologies unrelated to pregnancy, and 14% of the births were accomplished by means of cesarean section. Only 12.1% and 13% of the women, respectively, received information about postpartum contraception at the women's counseling sites and delivery wards. 46.3% of the women wanted to use IUDs, but only 7.3% wanted to use hormonal preparations. Only about half of the women expressed their opinion about sterilization: 23% were against it, while 29.7% were for it. The results indicated that the preparation of women for postpartum contraception should already start at the counseling place during pregnancy.^ieng

[New methodological approaches to assessing pregnancy outcomes]. / Novye metodicheskie podkhody k otsenke iskhodov beremennosti.

The authors present new methodologic approaches to analysis of the efficacy of maternity and childhood protection: reproductive loss, fetal and neonatal mortality comprising stillborns and infants dead before the age of 1 year, coefficient of late to early infant mortality, and population working potential loss. The said indexes were calculated for four territories of the Russian Federation. The results demonstrate a high share of induced abortions (the mean value 65%) among the causes of reproductive loss. A high share of perinatal loss (feto-neonatal mortality) necessitates increase of resources allotted to perinatal technology to 70%, this value being associated with working potential loss: 11.9 thousand man-years among men and 9.0 thousand man-years among women.

[The organizational aspects of reducing mortality from abortions]. / Organizatsionnye aspekty snizheniia smertnosti ot abortov.

PIP: Maternal mortality in the USSR in 1988 stood at 43/100,000 population. this figure broke down into mortality from ectopic pregnancy (5%); from induced and self-induced abortion (29.1%); and, from 28 weeks of gestation, mortality from births as well as during the postpartum period (65.9%). Prior to 1991, in 3 years 2020 women died of abortion-related causes, 76.7% of them in connection with non-medical abortions. The original medical documentation of 342 women who died of abortion was analyzed. 69.6% of the women died in connection with non-medical abortion. 72.6% of these women died during the period of 13-27 weeks of gestation. It was especially noteworthy that 58.8% of the women died in cases where their pregnancy was up to 12 weeks of duration and termination of pregnancy could have been performed. Contributory factors were intervention with the purpose of abortion outside of a medical facility, belated provision of medical help, and inadequate equipment at the medical facility. 78/1% of the deaths of non-medical abortions were caused by introduction of catheters or solutions into the uterine cavity and by the opening of the fetal sack through the use of drugs. 32 women carried out the intervention themselves, and 34 were done by strangers, including 18 medical personnel. Sepsis and peritonitis caused 88.6% of the deaths, and hemorrhage caused 6.7%. After induced medical abortions, 44.2% of women died from peritonitis and sepsis, 17.4% from extragenital diseases, and 26.9% from other causes. Only 22.7% of the cases were selected as case studies for medical conferences. Measures regarding the lowering of mortality from abortions have to be directed primarily at the prevention of non-medical or criminal abortions.^ieng

[Problems and prospects of establishing regional perinatology centers]. / Problemy i perspektivy sozdaniia regional'nykh perinatal'nykh tsentrov.

The paper provides a theoretical model of a regional perinatal centre based on many years of authors' practical experience in nursing newborns at high risk of perinatal pathology and also on international experience in the performance of similar centres and on multilevel system at large. The data are provided on the structure and functions of perinatal institutions, their equipment, manpower training, the system of management and possible economic provision.

[Methodological approach to the study of gynecologic diseases among children and adolescents]. / Metodicheskie podkhody k izucheniiu ginekologicheskoi zabole- vaemosti sredi detei i podrostkov.

Guidelines for the assessment of gynecologic morbidity in children and adolescents have been developed by the authors. A methodology of elucidation of gynecologic morbidity in children and adolescents was obtained and a classification of gynecologic diseases suggested. Efficiency of current therapy in childhood and adolescence as a determinant of reproductive health in womanhood is shown.

[The role of mass screening in reducing maternal and perinatal mortality]. / Dispanserizatsiia v snizhenii materinskoi i perinatal'noi smertnosti.

The change in antenatal care is discussed for the last 40 years. Evidence is presented on the efficacy of antenatal care with the advent of current approaches. Its role in the reduction of maternal mortality is shown.