Кафедра акушерства, гінекології та дитячої гінекології

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Administration of octaplex in comprehensive treatment of patients with profuse obstetrical hemorrhage
(2016) Osovskiy, I.; Blagoveshchensky, Roman; Grebenyuk, L.
Actuality. In spite of the advances in up-to-date medicine the treatment of postpartum hemorrhage remains a serious challenge for obstetricians. The incidence of such bleedings comprises up to 9-11% of the total number of deliveries. It is hemorrhage that conditions the fourth part of the causes of maternal mortality, of which over 70% result from disorders of hemostatic system, i.e. it can be considered a manifestation of DIC-syndrome. The incidence of profuse obstetric hemorrhage is 0.5 - 4.5% of the total number of bleedings. The aim was to analyze the effectiveness of administration of therapeutic agent Octaplex in the treatment of profuse obstetric hemorrhage. Materials and methods: the Department of Obstetrics, Gynecology and Children Gynecology assessed feasibility of administration and effectiveness of the therapy with this drug according to the instructions for the employment of medical immunobiological drug Octaplex 500 IU approved by the order issued by the Ministry of Health of Ukraine No.197 from 05.03.2010 Results of the study: The treatment of women with profuse blood loss was aimed both at surgical arrest of bleeding and at urgent replenishment of circulating blood volume. This method is not possible without infusion therapy and administration of drugs, activating hemostasis and preventing the development of coagulopathy. Development of hemorrhagic shock followed by a severe disruption of blood coagulation system is the most severe and life-threatening complication of blood and plasma loss. The action of this drug is aimed at the correction of coagulopathy. It contains several coagulation factors in high concentration: factor II - 220-760 IU, Factor VII - 180-480 IU, Factor IX - 500 IU, Factor X - 360-600 IU, protein S - 140-640 IU, protein C - 140-620 IU, heparin - 100-250 IU. Given the amount of clotting factors it can be said that one bottle of Octaplex 500 IU is equivalent to 1000-1500 ml of fresh frozen plasma. The average amount of blood loss was 950 mL (mean intraoperative blood loss - 620 ml), which corresponds to an average value of 21% of CBV, 1.53% of body weight. Indices of blood clotting before administration of Octaplex 500 IU (INR - 0.78, Quick’s prothrombin - 52.5%, blood clotting time - 5 minutes 41 seconds). Indices of blood clotting after administration of Octaplex 500 IU (INR-1.12, Quick’s prothrombin - 86.3%, blood clotting time - 7 minutes 23 seconds). Conclusion: Octaplex is an effective agent for the treatment of profuse postpartum hemorrhage and corrects coagulopathy.
Age-related diagnosis and treatment of ovarian cysts
(KhNMU, 2017-05-24) Kiebashvili, Solome; Gnatenko, Olga
Abdominal pain syndrome is one of the most frequent reasons for consulting a gynecologist.The purpose of the work was to improve early diagnosis of the causes of abdominal pain syndrome for timely organ-saving treatment of urgent conditions in girls and young women.Minimally invasive surgical procedure, laparoscopy with organ-saving operations should be considered the treatment of choice with regard to upcoming maternity.
Assessment of acute abdomen risk in adolescent and young reproductive age
(KhNMU, 2017-05-24) Prokopenko, Anastasia; Gnatenko, Olga; Nikolsky, Nikolay
Recently, more and more reports have appeared in the literature on the increase in the incidence of benign tumors and tumor-like ovarian formations in children, adolescents and young women. Pathological course of pregnancy and childbirth in mothers, complicated premorbid background and presence of inflammatory diseases of the female reproductive system in past history can be attributed to the risk factors for the development of tumors and tumor-like formations of the ovaries in adolescents and young women that trigger acute abdomen. The presence and extent of effusion in the abdominal cavity and the size of tumor-like formation are decisive for choosing the method of treatment in “acute abdomen”.
Assessment of basic parameters of heart rate in intrauterine infection
(2019-10-12) Vygivska, Liudmila; Vasylieva, Irina; Kalnytska, Violetta
The aim of this work was: to evaluate the basic parameters of cardiac rhythm in intrauterine fetal infection by cardiotocography. Results of cardiotocography findings in pregnant with IUI showed changes in the heart rate, which allows to predict the risk of adverse postnatal outcome.
Cervical polyp (clinical case)
(2016) Solyanik, V.; Chumak, A.
Actuality. Cervical polyps rank one of the first disorders among benign abnormalities as they affect 22.8% of gynecological patients and are often found in pregnant women. Pregnancy promotes active proliferative processes in the cervix, leading to reserve cell proliferation, microglandular hyperplasia and squamous metaplasia. Simultaneously, cervical polyps show decidual response of stroma. Pregnant women may have decidual pseudopolyps with local decidual changes in cervical stroma, which is shaped like a protruding plaque or a pseudopolyp. Clinical case. A pregnant 27-year-old patient A. was referred to gynecology department on 03/12/15 by a doctor from a maternity welfare clinic with blood-tinged discharge from the genital tract. The woman was examined and diagnosed with: pregnancy of 17 weeks and a decidual polyp. Present history. At the first consultation for registration she was diagnosed with pregnancy of 17 weeks and a decidual polyp. The woman was referred to hospital for treatment. Gynecologic status. External genitalia are without abnormalities. Body hair is of the female type. The vagina is narrow with clean vaginal mucosa. The cervix is conical in shape, without deformations, cervical epithelium is intact. A polyp of 1.8×0.5 cm in size is seen in the cervical canal. The body of uterus is increased to 17 weeks of pregnancy. The adnexa are not detectable. Vaginal vault is unobstructed and painless. Discharge is spotting and blood-tinged. On examination: complete blood count: hemoglobin 125 g /l, RBC 4.1×10/12, WBC 5.0×10/9, thrombocytes 220×10/9, BSR 24 mm/h, stabs-2%, segmented neutrophils-69%, eosinophils - 2%, lymphocytes-22%, monocytes - 5%; urinalysis: quantity 50.0 mL, color: light yellow, specific weight 1.010, alkaline reaction, WBC 10-12 within sight, transitional epithelium 0-2 within sight, much mucus. Colposcopy: a decidual polyp of 1.8×0.5 cm in size seen in the cervical canal. US findings: hyperechoic formation of 1.8×0.5 cm is visualized in the cavity of the cervix. Treatment. Decidual polyps during pregnancy are subject to immediate removal, if such symptoms are observed: • The formation bleeds constantly; • The surface of the polyp is found to have ulcerations; • The polyp triggers spasms and increases the tone of the uterus; • The infected polyp undergoes destructive changes. Conclusions. Polyps are removed by unscrewing using laser techniques and an endoscope, followed by thermo- and cryocautery. The method is minimally invasive and does not require scraping of the cervix, so it can be used in pregnancy. In this clinical case polypectomy is performed by unscrewing followed by histological examination of the removed tissue.
Clinical and etiologic characteristics of abnormal uterine bleedings in adolescent girls
(2016) Novikova, Anastasia
Actuality: Abnormal uterine bleedings of puberty (AUBP) are one of the most severe gynecological diseases in adolescents constituting 20-30% of all gynecological diseases in this age group. Issues of diagnosis, treatment and rehabilitation of patients with AUBP remain relevant, since recurrence worsens prognosis regarding reproductive function in these patients, which is still an important social and economic problem. The aim of our study was to evaluate clinical and etiological features of the development and presentation of new abnormal uterine bleedings in adolescents. Materials and methods: Assessment of medical records of 11-17-year-old adolescents with AUBP for the years 2014-2015 was performed at the Department of Obstetrics, Gynecology and Children Gynecology (Regional Children Clinical Hospital No.1 and Kharkiv Maternity Hospital No.1). Results: The study of medical records showed that 70% of patients developed AUBP at the age of 14-16 years, the majority of patients (77.5%) had new-onset bleedings and 22.5% of adolescents suffered from recurrent bleedings. Of these, 80% of girls did not undergo rehabilitation after the new-onset bleeding and did not seek gynecological help to restore menstrual function. The findings revealed that 55% of patients had such family histories of reproductive disorders as maternal menstrual dysfunction (MD), complicated perinatal period (hypoxia during labor, birth trauma, intrauterine pneumonia and other) in 45% of patients. The majority of patients were found to develop AUBP at unfavorable premorbid background: 67.5% of them had frequent acute respiratory viral infections and sore throat in prepubertal period. Besides, 60% of patients were diagnosed with chronic extragenital diseases (chronic gastritis, pyelonephritis, disorders of the nervous and endocrine systems). Conclusions: Thus, the study showed that AUBP more commonly occurs in adolescent girls 2-3 years after menarche. The study also determined multifactorial etiology of this disease: the impact of adverse perinatal period and premorbid background, the presence of extragenital pathology, as well as hereditary predisposition to MD. Absence of rehabilitation after new-onset bleeding is regarded as a risk factor of recurrence, which indicates the need for careful clinical examination of these patients in order to restore menstrual function during routine clinical examination.
Clinical diagnostic peculiarities of endometrial hyperplasia accompanied by hysteromyoma
(2015) Dudnichenko, N.; Pirozhenko, Yu.; Kolisnyk, A.; Fesenko, E.
Clinical pathogenetic characteristics of hormonal homeostasis in women with arterial hypertension following surgical menopause
(2015) Palamarchuk, V.; Vygivska, Liudmila; Blagoveshchensky, Evgeniy; Rogachova, Natella
Clinical pathogenetic characteristics of hormonal homeostasis in women with arterial hypertension following surgical menopause
(2015) Palamarchuk, V.; Vygivska, Liudmila; Blagoveshchensky, Evgeniy; Rogachova, Natella
Clinical presentation,diagnosis and treatment of adnexal torsion in children and adolescents
(2016-05) Gnatenko, Olga; Kiebashvili, Solome
Actuality. One of the most frequent causes of children admission to the surgical department is conditioned by abdominal pain, which can often result from gynecological diseases, particularly adnexal torsion (in 2-3% of cases). Adnexal torsion develops much more commonly in children and adolescents than in adult women, which is due to anatomical features of internal genital organs (small size of the uterus, a relatively high location of the ovaries in the small pelvis), physiological characteristics (overload of the bladder, juvenile constipation, overactive intestinal peristalsis), as well as more mobile lifestyle inherent to this age group. The aim. To study the incidence of adnexal torsion in children and adolescents. Materials and methods. The study involved clinical and statistical analysis of medical records of patients with diagnosed adnexal torsion, who underwent inpatient treatment at gynecologic department of Kharkiv Regional Children's Clinical Hospital from 2010 to 2016. Results. The assessment of the records for the period under investigation showed that adnexal torsion was diagnosed in 30 patients, including 11 girls under 12 years of age and 18 adolescents. Solitary torsion of the ovary was observed in 12 patients, torsion of an ovarian cyst - in 10, torsion of a paratubal cyst - in 5, torsion of the ovary and fallopian tube - in 2, torsion of ovarian teratoma - in 1. The treatment included 28 surgical operations by laparoscopy and 2 operations by laparotomy. Organ-preserving surgical treatment implied determination of the state of adnexal tissues: patients with intact blood flow and without necrotic changes underwent detorsion while adnexa with absent blood flow and presence of necrosis were removed. Conclusion. All cases of suspected adnexal torsion in children and adolescents need to be comprehensively diagnosed. Minimally invasive organ-preserving laparoscopic intervention should be considered the method of choice.
Comparative characteristics of the impact of various types of herpes infection on the condition of the fetus
(2020-10-16) Vygivska, Liudmila
Comparative characteristics of the action various types of herpes viruses on the condition of the fetus. Revealed that Type 6 herpes virus has a significant impact on the state of the fetus, which is manifested in changes in the fetoplacental complex and the development of fetal growth restriction in comparison with other types of this infection.
Cryopreservation of ovarian tissue to preserve oocytes of early stages
(Kharkiv : KhNMU, 2013-05-16) Feskov, V.
Implement cryopreservation of ovarian tissue of women under 30 years. Conduct in-vitro study to evaluate survival after thawing. Conduct animal-study in 4 laboratory animals (rabbits) to analyze ability of graft to folliculogenesis.
Current methods of cervical pregnancy diagnosis
(2016) Arsentyeva, Alina
Actuality: Cervical pregnancy (CP) is a rare form of ectopic pregnancy, which occurs at a frequency of 0.1-0.4% cases. CP development is conditioned by medical and surgical abortions, pelvic inflammatory diseases, uterine tumors and in vitro fertilization. CP is diagnosed when a trophoblast attaches to the cervical canal below the internal os. The fertilized egg grows into the muscle of the cervix to form a single hypervasculated complex, due to lack of decidua in the cervical canal. Therefore, patients develop profuse bleeding in disruption of the integrity of the gestational sac. Materials and methods: The study involved the assessment of medical histories of women with ectopic pregnancy who underwent in-patient treatment at gynecological department of Kharkiv Maternity Hospital No.1 for the last 5 years. Results: The assessment of current methods of CP diagnosis provided in the framework of the study showed that the diagnosis is based on clinical examination findings, human chorionic gonadotropin (hCG) level in blood, ultrasound (US), using color Doppler mapping (CDM) and magnetic resonance imaging (MRI). The study revealed that hCG level in blood does not correspond to CP gestational period. Increase in hCG concentration occurs slower than in normal pregnancy. Ultrasound examination with transabdominal and transvaginal probes determined the location and size of the uterus, identified myometrium structure, the presence or absence of myomatous nodules, endometriosis as well as localization and size of the gestational sac. Ultrasound and CDM of blood flow helped to visualize the location of chorionic vessels, evaluate vascularization of the uterus and its cervical division. MRI tomograms (1 case) clearly identified the margins between the chorion and cervical stroma. Sagittal and transverse sections provided reliable visualization of the gestational sac and helped to detect its size. Conclusions: Thus, complex cases of differential diagnosis, especially in intact CP, traditional clinical methods and determination of hCG in blood should be accompanied by diagnostically crucial up-to-date examination techniques, such as ultrasound with CDM and MRI of the pelvic organs.
Diagnosis of edometriosis in women of young reproductive age
(KhNMU, 2017-05-24) Ivanova, Tetyana; Korpan, Tetyana
Endometriosis of the ovaries is one of the important problems in modern gynecology. Diagnosis of ovarian endometriosis is a complex and multifaceted task. The final diagnosis is based on the results of histological examination. Medical-diagnostic laparoscopy is currently the optimal method for verifying the diagnosis and treatment of endometriosis in women of young reproductive age.
Diagnosis of uterine bleeding at puberty
(KhNMU, 2017-05-24) Skopenko, Anna; Krasun, Olga
Uterine bleeding at puberty (UBP) is one of the most common reproductive disorders during sexual development. Timely diagnosis of abnormal uterine bleeding at puberty is the key to successful preservation of the reproductive potential in this category of patients.
Diagnostics and treatment of femail adolescents and young women with ovarian cysts
(2014-03-05) Tuchkina, Irina; Piontkovskaya, Oksana; Gnatenko, Natalia; Tysyachka, Galina; Rubinskaya, Tatyana; Rogachova, Natella
The aim of this study has been to examine the clinical symptoms, the effectiveness of diagnostics, treatment and rehabilitation of patients with ovarian cysts of pubertal and young reproductive age. The effectiveness of treatment and reducing the number of relapses (of the functional cysts) depend on the correct assessment of the urgent situation and the differentiated approach to the choice of conservative and surgical therapy.
Dysmenorrhea in adolescents
(KhNMU, 2017-05-24) Dobrovolskaya, Larisa; Tuchkina, Marina
Dysmenorrhea ranks first among disorders of the menstrual cycle and is a neuroendocrine syndrome, which cyclically repeats, sometimes completely incapacitating girls during menstruation. The aim of the work is to study the risk factors for the development of dysmenorrhea of varying severity in adolescent girls.The study showed that adolescent dysmenorrhea in most cases (75%) occurs secondary to extragenital pathology. It allowed to determine the relationship between the nature of extragenital pathology and the severity of clinical manifestations of dysmenorrhea.
Endometrial hyperplasia. treatment and prevention at reproductive age
(2016) Stolbova, N.
Actuality.A high incidence of endometrial hyperplasia (EH) and the likelihood of malignancy put this pathological condition among the most urgent problems of modern medicine. Crucial clinical significance of EH identification lies in the fact that it is one of the most frequent causes of uterine bleeding and women's hospitalization. The aim of our study was to improve the treatment of women with endometrial hyperplasia (EH) and to determine the effectiveness of phytonutrient indole carbinol in complex treatment. Materials and methods. To achieve this goal we performed a retrospective study of 50 women of mean age 36.6±2.5 years, who underwent inpatient treatment from 2014 to 2016 at the Department of Obstetrics, Gynecology and Children Gynecology of KNMU. Indications for hospitalization of patients included uterine bleedings of different nature (85.6%) and presence of ultrasonographic findings of pathological changes of the endometrium (14.4%).Echography was regarded as an EH marker. An increase in the thickness of more than 16 mm and/or ultrasound signs of abnormal changes in its structure were considered to be one of the criteria of endometrial hyperplasia. The abovementioned signs were indications for morphological examination after therapeutic and diagnostic curettage of the uterus. Prior to and after the treatment (in 3 and 6 months) all women underwent tests to determine their hormonal profile (estradiol (E2) and progesterone (PRG)). The patients were divided into two clinical groups: the first group -25 women, who after curettage of the uterine cavity received combined oral contraceptives (COCs) (ethinylestradiol + desogestrel 1 tablet / day (30 mg) from the 1st day of menstrual cycle for 21 days, munali-30 -"Lupin Limited", a representative office in Ukraine) for 1-3 months; the second group consisted of 25 women who after curettage of the uterine cavity were administered COCs for 1-3 months and further till 6 months phytonutrients "Indole-F" (Farmakom, Kharkov) 1-2 capsules (1 capsule-90 mg), 2 times a day. Results. In the first clinical group E2 indices werenot significantly different before and after the treatment (before treatment: 21.5 ± 0.70 ng / ml; after treatment: 20.1 ± 1.3ng / ml); PRG levels tended to increase (before: 77.5 ± 8.1 ng/ ml; after 96.3 ± 7.2 ng / ml). In the second clinical group E2 levels decreased (before: 26.2 ± 1.1ng / ml; after: 19.6 ± 1.1 ng / ml), and PRG levels increases (before: 75.2 ± 5.4 ng / ml; after: 91.8 ± 2.7 ng/ ml).The study of findings in 6 months showed that EH relapses in the second group was observed 3 times less than in the first group 1 (12% vs. 32%) Conclusion.The study showed that administration of phytonutrients as part of comprehensive therapy of patients with EH improves the effectiveness of treatment and reduces the incidence of recurrence in women of reproductive age.
Endothelial dysfunction diagnosis in children and adolescents with inflammatory diseases in gynecological practice
(2015) Tysyachka, Galina; Semenchenko, L.; Mironchuk, K.; Solyanik, V.
Experience indole-3-carbinol in the treatment of retention cysts. (Case report)
(2015) Pylypenko, N.; Reznik, Marina; Rakytyanskyi, Igor; Rubinskaya, A.

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