[Clinical-morphological parallels in postpartum endometritis]. / Kliniko-morfologicheskie paralleli pri poslerodovom éndometrite.

Clinicomorphologic parallels were studied in 45 puerperants with postpartum endometritis. This condition was histologically confirmed in 42 of the 45 patients with its clinical symptoms (in 100% of patients with the grave, in 95% with the medium-severity, and in 83% of those with the benign form of the disease). The authors came to the conclusion that the severity of postpartum endometritis was directly dependent on the extent and depth of the uterine wall involvement in the inflammatory process. By the end of treatment the morphologic signs of inflammation persisted in 40% of patients even without clinical signs of endometritis. Such women should be referred to a group at high risk of developing chronic endometritis.

[Partial separation of sutures of the uterus after cesarean section (diagnosis and treatment tactics)]. / Chastichnoe raskhozhdenie shvov na matke posle kesareva secheniia (diagnostika i taktika lecheniia).

Echography supplemented by hysteroscopy helped detect signs of partial separation of the sutures on the uterus in 12 of 33 patients with grave endometritis following cesarean section. Therapeutic policy in such cases should be based on rational etiotropic antibiotic therapy and active local treatment of the involved focus (surgical treatment of the uterine cavity walls, drainage of the uterus, local multicomponent ointments with a hydrophilic base). The treatment helped preserve the uterus and resulted in complete cure in 11 of the 12 cases.

[Clinical value of telethermography in the diagnosis of puerperal mastitis]. / Klinicheskoe znachenie teletermografii v diagnostike poslerodovogo mastita.

The study in 209 mothers with lactational mastitis has employed an AGA-780M thermovisor. Thermograms underwent a qualitative and quantitative isotherm-based evaluation. Diagnostic sensitivity of telethermography in mastitis was 97.1%. It could not differentiate types of mastitis in most cases and thus had a low specificity. Telethermography allows early identification of mastitis, control of therapy and reduction of the incidence of suppurative mastitis. The opportunity of telethermographic differentiation of milk stasis and initial mastitis has important practical implications since it allows one to avoid inappropriate use of antibiotics.

[Abortion as a cause of maternal mortality]. / Abort kak prichina materinskoi smertnosti.

It has been shown that 65.8% of 343 women died in the second trimester and 69.6% after an illegal abortion. Sepsis and peritonitis were the main causes in the general population (73.9%) and in women who died from illegal abortions (88.6%). Defects in medical care were found.

PIP: The medical documents of 342 women who died as a result of abortion (induced, self-induced, and outside of hospitals) were analyzed. 24.2% of the women were under 24 years of age, 51.3% were 25-34 years old, and the rest were 35 or older. 69.9% of the women died after abortion outside of hospitals and the rest after self-induced and induced abortions. 65.8% of the women were pregnant at 13-27 weeks of gestation. The death of 186 of 238 women was due to abortions performed outside of hospitals. Most of these were the result of invasive methods (the introduction of the catheter, solutions, rupture of the amniotic sac). These women subsequently received medical assistance. 93.3% of them were hospitalized with delay, and only 2.6% were admitted in satisfactory condition. In a significant proportion of patients the examination was belated and inadequate. Various laboratory hematological tests that were essential for diagnosis and determination of the severity of the process were not done. The bacteriological tests to select the appropriate antibacterial drug were rarely performed--the tests were done for only 19.8% of women who had died of sepsis and for 14.3% of those who had died of peritonitis. Inadequate care manifested itself in the fact that diagnosis was established for only 46.8% of patients. Sepsis and peritonitis were the cause of death for 73.9% of all women and for 88.6% of those who died of abortion outside the hospital. Hemorrhage was the second most frequent cause, with 42 women dying because of it. Other causes were anaphylactic shock and thromboembolism of the pulmonary arteries. The elimination of such causes of death mandate goal-oriented preventive measures accompanied by diagnosis and therapy and the raising of the knowledge level of the medical personnel about purulent-septic infections. A radical improvement in bacteriological care also must be effected.

[Artificial late abortion for medical genetic indications]. / Iskusstvennoe preryvanie beremennosti v pozdnie sroki po mediko-geneticheskim pokazaniiam.

Late abortions have been induced for genetic indications in 96 women using intra-amniotic administration of 20% sodium chloride or Enzaprost. The results were compared within this group and with a control group of 90 women whose pregnancies were terminated for other indications at similar dates and with the same agents. The use of 20% sodium chloride was associated with significantly higher blood loss and greater lengths of abortions. Patterns and rates of complications were comparable in both groups. These data suggest a utility of 20% sodium chloride and, especially Enzaprost, in late pregnancy termination for genetic indications.

[The importance of echography and hysteroscopy in the diagnosis and basis of a rational therapy for intrauterine pathology after labor]. / Znachenie ékhografii i gisteroskopii v diagnostike i obosnovanii ratsional'noi terapii vnutrimatochnoi patologii posle rodov.

Echography with hysteroscopy has been employed in 40 mothers with a complicated postpartum period. Ultrasound diagnosis of intrauterine disease is technically simple, noninvasive and efficient in measurement of the uterus and identification of abnormal inclusions in the uterine cavity. Hysteroscopy allows characterization of the abnormal intrauterine inclusions and evaluation of the endometrium. In addition, hysteroscopy enables additional diagnostic and therapeutic procedures. This study resulted in a protocol of postpartum examination of patients using echographic and hysteroscopic diagnostic methods.

[Ampicillin pharmacokinetics in pregnant women with acute pyelonephritis]. / Farmakokinetika ampitsillina u beremennykh s ostrym pielonefritom.

The pharmacokinetics of ampicillin was studied in 38 patients with acute pyelonephritis in the second and third trimesters of pregnancy after the first and the last (28th-32nd) intramuscular injections of the antibiotic. The ampicillin levels in the blood and urine were determined with the agar diffusion method. The pharmacokinetic parameters were estimated in a one-compartmental model by computer The ampicillin levels in the blood and urine of the patients did not practically differ at all the investigation periods (0.5-6 hours after the antibiotic administration) in the second and third trimesters of pregnancy. During the treatment, the rate of ampicillin elimination from the host increased and the period of half-elimination from the blood decreased. The antibiotic levels in the urine within 4-6 hours after the last injection were practically lower in the second trimester of pregnancy as compared with the second trimester. The therapy resulted in an increase in the antibiotic renal clearance, which returned to normal in the second trimester of pregnancy and remained under normal in the third trimester of pregnancy. The increase was due to an approximately 2-fold acceleration of the rate of ampicillin secretion by the renal tubules. The total clearance of ampicillin practically increased in the second trimester of pregnancy and remained decreased in the third trimester of pregnancy. The estimation performed in accordance with the Krueger-Timmer principles on the basis of the characteristic features of the pharmacokinetics of ampicillin shown in the study provides recommendation of the following scheme for pyelonephritis treatment in pregnant women: 500 mg of ampicillin injected intramuscularly every 6 hours followed by gradual decreasing of the intervals between the injections to 4 hours as the rate of ampicillin elimination increases.