PRENATAL EXAMINATION OF THE PLACENTAL COMPLEX AND FETAL STATUS IN DIFFERENT UMBILICAL PATHOLOGIES

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Posibilitatea aprecierii antenatale a stării cordonului ombilical (CO), identificării patologiei existente prin modularea fluxului sangvin este relativ recentă, ce se datorează, în foarte mare măsură, creșterii performanțelor prin investigația ecografică și velocimetria Doppler. Concomitent și monitorizarea electronică a ritmului cardiac fetal are avantaje certe în urmărirea travaliului, comparativ cu auscultația cordului fetal, în special atunci când riscul de suferință fetală este înalt. Scopul lucrării. Evaluarea complexă a sistemului fetoplacentar prenatal în diferite patologii ale CO. Material și metode. Realizat un studiu prospectiv de cohortă cu repartizare respondentelor în două loturi: cu (L 1) sau fără (L 0) patologia CO. Au fost utilizate 3 metode de cercetare care se completează reciproc: USG, velocimetria Doppler și CTG. Semnificația statistică a fost egală cu 0,05. Rezultate. La gravidele cu patologie a CO, la examenul USG convențional și velocimetrie Doppler, mai frecvent s-au constatat modificări în placentă (p<0,05), care au fost însoțite de insuficiență circulatorie placentară (χ 2 1df = 10,5556, V Cramer = 0,23; p = 0,001) cu dezvoltare a RCF. Tot în acest lot de cercetare traseul CTG s-a identificat mai frecvent ca suspect și patologic, comparativ cu lotul-martor (χ 2 2df = 54,45, V Cramer = 0,54; p<0,0001). Bolile CO în care s-a determinat insuficiența circulatorie sunt următoarele: inserție velamentoasă (p = 0,04), AOU (p = 0,0004), varice (p = 0,0004), CO subțire din cauza lipsei gelatinei Wharton (p = 0,02), CO gros (p = 0,0005), CO hiporăsucit/torsionat (p = 0,0009), funisită (p = 0,02). Concluzii. La USG mai frecvent se constată modificări patologice în placentă, care urmează a fi interpretate tangențial ca semne de insuficiență placentară, dezvoltare a RCF în condițiile stării de hipoxie în lotul de bază. CTG a fost utilizată pentru a diagnostica consecințele patologiei CO, care a provocat dereglările fluxului sangvin ombilical, manifestată prin semnele incipiente ale hipoxiei intrauterine.Background. The importance given to umbilical cord (UC) pathology in modulating fetal blood flow is relatively recent and were obtained through ultrasound examination with Doppler velocimetry. Electronic fetal heart rate monitoring has clear advantages in monitoring labor compared to fetal heart auscultation, especially when there is a high risk of fetal distress. Objective of the study. To evaluate the placental complex and fetal status in different umbilical cord pathologies. Material and methods. A prospective cohort study has been conducted. The patients were divided in two groups: with UC pathology (L1) or without (L0). Within the conducted study, in order to evaluate the fetal and placental system comprehensively, three research methods were used that complement each other: ultrasound examination (US), Doppler velocimetry, and cardiotocography (CTG). The statistical significance was 0.05.Results. In pregnant women with UC abnormality, pathological changes in the placenta (p<0.05) were more frequently, which were associated with by placental circulatory insufficiency (χ 2 1df = 10.5556, V Cramer = 0.23; p = 0.001) with the development of FGR. In the study group, the cardiotocographic trace was identified more frequently as suspect and pathological compared to the control group (χ 2 2df = 54.45, V Cramer = 0.54; p<0.0001). The UC pathologies in which circulatory insufficiency was determined are as follows: velamentous insertion (p = 0.04), single umbilical artery (p = 0.0004), varices (p = 0.0004), thin cord due to the absence of Wharton’s jelly (p = 0.02), thick cord (p = 0.0005), hypocoiling or torsion cord (p = 0.0009), and funisitis (p = 0.02). Conclusion. During US examination, pathological changes in the placenta are more frequently observed, which are to be interpreted tangentially as signs of placental insufficiency and the development of fetal distress in the presence of hypoxia in the research group. CTG was used to diagnose the disruption of umbilical blood flow and incipient signs of intrauterine hypoxia

Материнская смертность – актуальная медицинская и социально – демографическая проблема для Республики Молдова

Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Departamentul de Obstetrică și GinecologieIntroduction. Maternal mortality is an important demographic societal mark that indicates the interdependence of medical practice, managerial efforts, socio-economic and environmental factors. That is, it reveals not only the somatic and reproductive health condition of women, quality of obstetrical services or the functioning of institutions of Obstetrics and Gynecology, but also suggests the rate of efficiency for the entire health system. The issue of maternal mortality remains stringent in Republic of Moldova (RM0, displaying unsatisfactory high rates, as a result of a prolonged demographic and socio-economic crisis, that has been affecting the country the past decades. The aim of the study. Evaluate maternal mortality cases registered in the RM between 1990-2019, by analysing the evolution, tendencies, structure of maternal death cases, together with the medical and social factors that influenced the maternal mortality rate. Materials and Methods. This paper performs an analysis of maternal mortality cases in RM between 1990-2019. Specifically, the research represents a retrospective, descriptive study based on random sampling (years 1990-2008; 2009-2019) and studies the cases of maternal death based on criteria of time, place and circumstances. Also, the survey includes a transversal study of a selected sample (2009-2014), by means of customized questionnaires. The data was processed through statistical programming using SPSS 20. Results. Since the declaration of independence until 2019, there were 1 211 840 births registered in RM, out of which 1 176 446 infants born alive, 697 101 pregnancies ending in abortion and 355 cases of maternal mortality. Between 1990-2008, the rate of maternal mortality fell from 53,2 to 38,4 per 100 000 newborns. The majority of death cases were registered among women from rural areas (62,2%), relative to women from urban areas (37,8%), as well as 2/3 of maternal deaths were associated with direct obstetric causes (62,5%), versus indirect maternal deaths (37,5%). Further, in the following decade, 2009-2019, there were 90 cases of maternal deaths. Even though there were significant improvements employed in the medical system, perinatology services and specialized medical institutions, the rate of maternal mortality in RM has not dropped sufficiently, remaining relatively high compared to other countries in Europe (17,2 per 100 000 live births in 2009; 16,8 per 100 000 live births in 2019). The results suggest that maternal mortality rate is highly influenced by unfavorable socio-economic factors, social injustice and social vulnerability of women, i.e. inferior living standards, violence at home, poor financial situation, migrating lifestyle, employment abroad, low education, neglecting professional help. Moreover, the issue of maternal mortality at home remains stringent. Namely, one out of four cases occurred outside the hospital (23,2%), prevailing among women from rural areas (66,7%) and women with severe social issues, such as violence and poor living standards (67%). Therefore, the study established that during the last 30 years (1990-2019), there were 431 registered cases of maternal mortality in RM, out of which 241 (59%) maternal deaths resulted from direct obstetric causes and 176 (41%) as a result of non-genital pathogens. Also, the majority of death cases in this period were registered among women from rural areas (68%). Conclusion. Maternal mortality ratio in RM decreased signifi cantly in the past decades, although still remaining high relative to other countries in Europe. Maternal deaths are mainly registered among women from rural areas and cases of home births.Введение. Материнская смертность является важнейшим демoграфическим показателем, который отражает не только способности медицинской системы, но и состояние общества в целом, его социально-экономическое развитие и управленческие возможности. В Республике Молдова (РМ) материнская смертность продолжает оставаться актуальной проблемой, с неприемлемо высоким коэффициентом смертности, на фоне продолжающегося в последние десятилетия демографического и социально-экономического кризиса. Цель исследования. Oценка случаев материнской смертности, зарегистрированных в РМ в 1990–2019 гг., c определением эволюции, тенденций, структуры, причин материнской летальности, медико-социальных факторов обуславливающих материнскую смертность. Материалы и методы. Проведено ретроспективное (1990–2008 гг.) и проспективное (2009–2019 гг.) исследование случаев материнской смертности, имевших место в РМ в периоде 1990-2019 годах. Сбор материала осуществлялся методом анкетирования. Обработка полученных данных производилась с использованием пакета прикладных компьютерных программ SPSS 20 и Microsoft Excel 2010. Результаты. С момента провозглашения независимости и до 2019 года в РМ было зарегистрировано 1 211 840 родов, родилось 1 176 446 живых детей, 697 101 беременностей закончилась абортом и имело место 355 случаев материнской смертности. В течение 1990-2008 годов уровень материнской смертности снизился с 53,2 до 38,4 на 100 000 живорождений, при этом из всех случаев смертности доля женщин из сельской местности составила 62,2%, а городского населения 37,8%. В структуре материнской смертности в 2/3 случаев преобладали прямые акушерские причины (62,5%) по сравнению с косвенными (37,5%). В следующем десятилетии, 2009-2019 гг., в республике зарегистрировано 90 случаев материнской смертности и несмотря на то, что были предприняты многочисленные усилия на уровне всей медицинской системы, перинатальной службы, медицинских учреждений, в республике не было отмечено явного снижения уровня материнской смертности, а показатель смертности остался достаточно высоким по сравнению с другими европейскими странами (17,2 на 100 000 живорождений в 2009 году; 16,8 в 2019 году). В результате исследования было установлено, что на уровень материнской смертности существенное влияние оказывали неблагоприятные социально-экономические факторы, социальное неравенство, уязвимый социальный статус женщин, такие как: низкий уровень жизни, отсутствие достойных условий жизни, наличие бытового насилия, происхождение из бедных семей, миграционный образ жизни и работа за границей, низкая общая культура, пренебрежение медицинской помощью. Достаточно актуальной в Молдове остается проблема материнской смертности вне больничных условиях, каждая четвертая материнская смерть произошла на дому (23,2%), с высокой распространенностью среди женщин из сельской местности (66,7%), женщин с серьезными социальными проблемами, насилием в семье, плохими бытовыми условиями и низким уровнем жизни (67%). Проведенное исследование установило, что на протяжение 30 лет (1990-2019 гг.) в РМ было зарегистрировано 431 случай материнской смертности, из них от прямых акушерских проблем умерла 241 женщина (59%), от косвенных 176 (41). %). Абсолютное большинство случаев материнской смертности в этот период приходилось на женщин из сельской местности (68%). Выводы. Уровень материнской смертности в РМ значительно снизился за последние десятилетия, но продолжает оставаться достаточно высоким по сравнению с другими европейскими странами. Материнская смертность преобладает среди женщин из сельской местности, и недопустимо распространенными являются случаи смерти на дому

Obstetrics and gynecology – a field with traditions, innovations, challenges and modern opportunities

Disciplina obstetrică şi ginecologie, Departamentul de obstetrică şi ginecologie, Universitatea de Stat de Medicină şi Farmacie ,,Nicolae Testemiţanu”, Chişinău, Republica Moldov

Оценка кадрового потенциала врачей акушеров-гинекологов родильных домов Республики Молдова

Universitatea de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra Obstetrică-Ginecologie, FECMFIntroduction. Modern technologies and technical equipment enabled the improvement of the obstetrical health service activity. However, the final results depend on the capacity and potential of available medical staff. The goal of the study. Potential assessment of the obstetrician and gynecological doctors in maternity hospitals of the Republic of Moldova. Materials and methodology. In the study, there were used the official statistical data and was applied a questionnaire of 53 questions, which involved 363 respondent obstetrician and gynecological doctors. The objective of this questionnaire was to found out the opinions of doctors towards their motivation, professional preparation, attitude towards the institution, professional risks and difficulties, etc. There were applied several research methods: comparative, analytical research, biostatistics, mathematics; and data collection methods: questionnaire, collection of data from medical documents, statistical reports, analysis of documents. Data were processed with Microsoft Excel statistics applications, indicators and statistical correlations are represented in diagrams and graphics, correlation and contingency tabs. Results. It was found that the average age of obstetrician and gynecological doctors in maternity hospitals of the Republic of Moldova is 50,95 ± 1,7 years and the superior qualification category is hold by 56,8% of specialists. In perinatal centers of the I-st level, there are working 38,9% of doctors, II-nd level – 45,2%, III-rd level – 15,9%. The retirement age has reached 32% of employed doctors. About 46,86% ± 2,6 respondent doctors consider the living standard as „low“ and 74,1% ± 2.29 have the necessity to work over the working hours. 61,7% ± 2,55 specialists experienced several difficulties at work. 42,7% ± 2,59 from the total number of 363 interviewed doctors who wouldn’t like their children to become doctors. Conclusions. The average age of obstetrician and gynecological doctors is fairly high and ranges between 50-60 years. It is high the percentage of employees of retirement age, on the background of insufficient salaries, which could create difficulties in the future years for ensuring the institutions with medical staff. The crisis in the potential of doctors is amplified by low motivation, both for material and professional development, due to the high age factor and poor remuneration. Also, is important to mention that society‘s attitude towards doctors, the way mass media present the medical activity, and involvement of legal institutions in doctors’ activity deteriorates the attractivity of specialty and decreases significantly the motivation of medical staff. Moreover, the study found that the medical staff considers deficient the support from their medical institutions and the state. All these emphasize the acute necessity for the development of activities to attract and motivate the medical staff, in order to overcome the staff crisis that could affect the medical system in the future years.Введение: существующие современные технологии, оснащение медицинским оборудованием позволило значительно улучшить оказание акушерской помощи. Однако, внедрение новых технологий возможно только при наличии достаточного кадрового потенциала. Цель исследования: анализ кадрового потенциала специалистов - акушер-гинекологов родильных домов Республики Молдова. Материалы и методы: в исследовании использованы официальные статистические данные, а также результаты анкетирования 363 врачей акушеров-гинекологов. Анкета состояла из 53 вопросов, включающих данные о степени профессиональной подготовки врачей, персональные мотивации, оценки работы учреждения специалистами, трудности и риски профессиональной деятельности и т.д. Для исследования использованы анкеты, отчеты, статистические данные, которые были проанализированы сравнительными, аналитическими, биостатистическими и математическими методами. Полученные данные обработаны статистическими программами Microsoft Excel SP, “Pentium-4”, представленными в виде таблиц, графиков и диаграмм. Результаты: было установлено, что средний возраст врачей-акушеров родильных домов составляет 50,95±1,7 года, 56,8% специалистов имеют высшую квалификационную категорию, в перинатальных центрах I уровня трудится 38,9% врачей, II уровня - 45,2%, III уровня -15,9%. Врачи пенсионного возраста составляют 32% от общего количества специалистов. Около 46,8% из анкетированных специалистов считают свой жизненный уровень низким, а 74,1% вынуждены работать сверх предусмотренной нормы, 61,7% сталкиваются с трудностями в процессе профессиональной деятельности, 72,7% из опрошенных не желают чтобы их дети начинали медицинскую карьеру. Выводы. Средний возраст врачей акушеров-гинекологов достаточно высок и варьирует между 50-60 годами, высок уровень работающих пенсионеров. Этот кризис усугублен за счет слабой мотивации врачей из-за низкой материальной обеспеченности, снижения престижа врачебной профессии в обществе (здесь не последнюю роль сыграли средства массовой информации, которые часто некорректно освещают работу врачей); и учащение случаев не совсем обоснованного юридического преследования. Сложившаяся ситуация может привести к дефициту кадров в родовспомогательных учреждениях в последующие периоды. Учитывая вышесказанное, необходимо принять меры для улучшения потенциала медицинских кадров, в противном случае могут возникнуть трудности в обеспечении функционирования акушерской службы

Материнские осложнения связанные с прегестационным ожирением

Pregnancy is characterized by a multitude of physiological changes, which unfortunately can aggravate the general maternal condition. Pre-gestational obese women are prone to more complicated specific pregnancies, also, all changes during pregnancy can directly or indirectly affect the condition of the fetus intrauterine. The article presents the results of a literature review on maternal complications during pregnancy in obese women. Obese pregnant women face multiple risks compared to normal weight women. Higher anesthetic complications, high operative morbidity, more medical complications, high accident rate, sleep apnea, psychological disorders and other social and family problems. Obesity is associated with various medical complications that precipitate even more during pregnancy, so the obstetrician must be aware and alert about possible complications such as hypertension, pregnancy-induced hypertension, preeclampsia, gestational edema, varicose veins, sleep apnea, hypoventilation, gestational diabetes. It has been found that many of the maternal-fetal risks that arise during pregnancy are linearly dependent on BMI (body mass index). Obese women often have extended first and second periods of labor. Early maternal exhaustion, insufficiency of contraction forces leads to increased incidence of instrumentally assisted births or cesarean section. Postpartum hemorrhage is four times more common in obese pregnant women compared to normal weight women. Obesity is a social and medical challenge that requires vigilant supervision by health care providers.Беременность характеризуется множеством изменений в женском организме, которые при определенных условиях, могут значительно усугубить состояние матери. В свою очередь, эти изменения прямо или косвенно, влияют на состояние внутриутробного плода. Ожирение является фактором риска по многим показателям, особенно при беременности, когда материнский организм функционирует с повышенной интенсивностью, провоцируя многочисленные осложнения по сравнению с беременными женщинами с нормальным весом. В статье представлены результаты обзора литературы материнских осложнений при беременности у женщин с ожирением. У этой категории беременных чаще отмечаются гестационный диабет, гестационные отеки, гипертония, гипертензия, вызванная беременностью, преэклампсия, анестезиологические осложнения и высокая послеоперационная заболеваемость. Кроме того отмечено более частое появление варикозного расширения вен, апноэ во сне, гиповентиляции, психологических расстройства, высокая частота несчастных случаев, другие социальные и семейные проблемы. Установленно, что многие риски для матери и плода, возникающие во время беременности, линейно зависят от ИМТ (индекса массы тела). У тучных женщины чаще наблюдается раннее истощение матери, удлиненный первый и второй периоды родов, недостаточность сократительных сил, что приводит к увеличению частоты инструментальных родов или кесарева сечения. Отмечено, что послеродовое кровотечение в четыре раза чаще встречается у беременных с ожирением, по сравнению с беременными с нормальным весом. Таким образом, ожирение связано с различными медицинскими и социальными осложнениями, усугубляющимися во время беременности, что требует бдительного наблюдения со стороны акушеров-гинекологов и других специалистов

The effect of analgesia in labor on the intrauterine state of the fetus

Catedra de Obstetrică şi Ginecologie (FECMF) a USMF „N. Testemiţanu” ² Catedra de Obstetrică şi Ginecologie a USMF „N. Testemiţanu”The study was directed to evaluate the effect of epidural analgesia and Promedol analgesia during labor on intrauterine fetal condition. Analgesic efficiency of methods, the maternal adverse effects and duration of labor were evaluated. The results showed that epidural analgesia is more frequently associated with maternal hypotension, increased duration of labor and more frequent administration of oxytocin to stimulate uterine contractions. Both types of analgesia: epidural and Promedol induce deterioration of fetal heart rate without significant effect on newborn condition at birth. Epidural analgesia is associated more frequently with a rise of fetal heart rate and occurrence of variable decelerations. These changes may be due to maternal hypotension. The changes are usually transient and do not cause maternal or fetal morbidity. Systemic analgesia with Promedol is associated more frequently with suspicious and pathological cardiotocografic patterns and a higher rate of instrumental births. Promedol administered during childbirth reduces variability of the fetal heart rate and mask the reduced variability associated with hypoxia. Our results confirm the need for confirmation of a reactive normal cardiotocografic pattern, without signs of fetal hypoxia before administering any type of labor analgesia. The existence of serious heart rhythm abnormalities on the fetal CTG represents a contraindication for administration of analgesia. Studiul a fost orientat spre evaluarea comparativă a efectului analgeziei peridurale şi a analgeziei intravenoase cu promedol în timpul naşterii asupra stării intrauterine a fătului. Au fost evaluate eficacitatea analgezică a ambelor metode, efectele adverse materne şi durata naşterii. Rezultatele obţinute au demonstrat că analgezia peridurală se asociază mai frecvent cu hipotensiune arterială maternă, creşterea duratei travaliului şi administrarea mai frecventă a oxitocinei cu scop de stimulare a contracţiilor uterine. Ambele tipuri de analgezie: peridurală şi promedolul modifică traseele cardiotocografice fără a influenţa seminificativ starea nounăscutului la naştere. Analgezia peridurală se asociază mai frecvent cu creşterea frecvenţei cardiace fetale şi apariţia deceleraţiilor variabile. Deteriorarea ratei cardiace fetale se poate datora hipotensiunii materne. Aceste modificări sunt de obicei tranzitorii şi nu produc morbiditate maternă sau fetală. Analgezia cu promedol se asociază mai frecvent cu apariţia traseelor cardiotocografice suspecte şi patologice cu o rată mai mare a naşterilor intrumentale. Promedolul administrat în timpul naşterii reduce variabilitatea bazală şi maschează variabilitatea bazală diminuată asociată cu o hipoxie preexistentă. Rezultatele obţinute confirmă necesitatea confirmării traseului cardiotocografic reactiv şi normal, fără semne de hipoxie fetală anterior administrării oricărui tip de analgezie a travaliului. Existenţa anomaliilor grave ale ritmului cardiac fetal pe traseul CTG reprezintă o contraindicaţie pentru administrarea analgeziei

Rezultatele implementării tehnologiilor moderne în Centrul perinatologic municipal din or. Chişinău

În studiul dat sunt prezentate rezulatele implementării tehnologiilor moderne în asistenţa spitalicească obstetricală. Rezultatele obţinute în asistenţa perinatală demonstrează că activitatea medicală poate servi ca model pentru activitatea centrelor perinatale din ţară

Психопрофилактическая антенатальная подготовка

Universitatea de Stat de Medicină și Farmacie “Nicolae Testemițanu”, Departamentul de Obstetrică și GinecologieIntroduction: A pressing issue in modern obstetrics is women’s preparedness for childbirth, both from a medical and psycho-emotional perspective. The psycho-emotional state and birth readiness of a pregnant woman, on a great extent determines the future course of labor. Multiple psychological and emotional factors cause potential complications during childbirth and damage the obstetric and perinatal outcomes. Aim: Assessing the development and effectiveness of psychoprophylactic preparation of pregnant women, and estimating the impact of antenatal training on childbirth. Materials and Methods: The study is based on a survey of 299 participants. The inquiries involved questions on overall health condition, observations during pregnancy, experience during delivery and psychological training. The data was processed through statistical analysis. Results: The inquiry indicates that 104 participants (34,8%) found out about the existence of psychoprophylactic training only after the childbirth as a result of our inquiries. Further, 195 women (63,5%) were informed about prenatal training by diverse sources, but only 71 (23,7%) pregnant women participated in psycho-prophylactic trainings and 228 (76,3%) did not follow any kind of prenatal education. The largest share of guidance was provided by the obstetriciangynecologist (79%), followed by the psychologist (60%) and the family doctor that was involved up to 21% of the time. Obtained results also point out that birth analgesia was applied to 90 respondents (30%), of which 68.8% did not attend psychoprophylactic training courses. Among the pregnant women that followed the training program, 75% of cases did not involve obstetric trauma during delivery process. In contrast, 2/3 of the participants who did not follow the educational program encountered some kind of leisons of reproductive tissues. Conclusions: Obtained results confirm the benefits of antenatal psychoprophylactic training. This type of training helps minimize and exclude negative psychoemotional factors and is therefore an effective way of preventing birth complications and improving birth experience.Введение: Готовность женщины к родам с медицинских и эмоциональных точек зрения является одним из актуальных вопросов современного акушерства. Психологическое состояние женщины, ее подготовленность к процессу родов, во многом определяет физиологическое течение родового акта. Многие психологические и эмоциональные факторы обусловливают возникновение осложнений в процессе родов, способствуют ухудшению акушерских и перинатальных исходов. Цель исследования: Оценка развития процесса психопрофилактической антенатальной подготовки беременных женщин, его эффективности и влияния на течение родов. Материалы и методы: В исследовании использованы результаты анкетирования 299 родивших женщин, которые состояли из общих клинических вопросов, а также вопросов по антенатальному наблюдению настоящей беременности, течению и исхода родов, посещения тренингов подготовки к родам. Статистическая обработка и анализ выполнялся с использованием статистических программ.Результаты: O существовании психопрофилактической программы дородовой подготовки 104 женщины (34,8%) узнали уже после родов, в процессе анкетирования. Во время настоящей беременности об этой форме обучения информированы из разных источников 195 (63,5%) женщины, но только 71 беременная женщина (23,7%) участвовала в психопрофилактических тренингах, а 228 (76,3%) не посещали никаких занятий. Основным тренером в учебном процессе был врач акушер-гинеколог (79%), за которым следовали психолог (60%) и семейный врач, который принимал участие только в 21% случаев обучения. Результаты исследования показали, что обезболивание родов было применено к 90 респондентам (30%), из которых 68,8% не посещали психопрофилактические учебные курсы. У беременных женщин, принимавших участие в тренингах, роды закончились без акушерской травмы в 75% случаев, в отличие от беременных, не посещавших курсы, у которых в 2/3 случаях имели место разрывы мягких тканей родовых путей. Выводы: Психопрофилактическая подготовка беременной пациентки позволяет добиться минимизации и устранения негативных психо-эмоциональных факторов, являясь эффективным средством предупреждения осложнений и улучшения исходов родов

The impact of endometriosis on in vitro fertilization outcomes

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Endometrioza este o maladie inflamatorie definită prin prezența țesutului endometrial în afara cavității uterine, care afectează 10-15% din populația feminină. Ea este o cauză majoră a infertilității prin diferite mecanisme. Endometrioza este asociată cu rezerva ovariană diminuată, deseori iatrogen, după chistectomii repetate, răspuns slab la stimularea ovariană, ovocite și embrioni de calitate scăzută, cauzate de prezența în lichidul peritoneal al citokinelor proinflamatorii, receptivitate endometrială alterată și rate scăzute ale sarcinii spontane sau obținute prin fertilizare in vitro (FIV). Scopul lucrării. Evaluarea impactul endometriozei asupra succesului FIV. Material și metode. A fost realizat un studiu bibliografic pentru ultimii 5 ani, fiind căutate îmbinările de cuvinte: „endometriosis” și „in vitro fertilization” în motorul de căutare disponibil gratuit, open-acces – Google Scholar. Ca rezultat au apărut peste 50 de surse. Din ele au fost analizate 20 de surse, care au fost relevante tematicii, incluzând toate aspectele puse în discuție. Rezultate. Nivelul Hormonului antimullerian (AMH) a scăzut chiar și în absența intervenției chirurgicale până la 26,4% în jumătate de an la femeile cu chisturi endometriale. La aceste femei s-au obținut un număr mai mic de ovocite și embrioni și rată mai mare de avort spontan. Manifestările clinice au fost în corelație cu severitatea maladiei și au fost explicate prin răspunsul inflamator pelvian și stresul oxidativ. Rata de apariție a sarcinii a fost mai mică la pacientele cu endometrioză deseori din cauza exacerbării patologiei. Concluzii. Endometrioza este una din cele mai comune patologii cu impact negativ asupra fertilității feminine. Procedura FIV la pacientele cu endometrioza necesită doze mai mari de gonadotropine și timp mai mult de stimulare ovariană.Introduction. Endometriosis is an inflammatory disease defined by the presence of endometrial tissue outside the uterine cavity, affecting 10-15% of the female population. It is a major cause of infertility through various mechanisms. Endometriosis is associated with diminished ovarian reserve, often iatrogenic, consequence of repeated cystectomies, poor response to ovarian stimulation, low-quality oocytes and embryos, presence of proinflammatory cytokines in the peritoneal fluid, altered endometrial receptivity and low rates of spontaneous or conceived through in vitro fertilization (IVF) pregnancies. Objective of the study. Evaluation of endometriosis’ impact on IVF efficacy. Materials and Methods: It was accomplished a bibliographic study, including material published within the last 5 years, by searching for word combinations: „endometriosis” and „in vitro fertilization” in the free, open-access search engine - Google Scholar. As a result, more than 50 sources have appeared, from which 20 (more relevant, including all discussed aspects of the topic) - were analyzed. Results. The level of Anti-Mullerian Hormone (AMH) has decreased even in the absence of surgery up to 26.4% in half a year in women with endometrial cysts. These women had a lower number of oocytes and embryos and a higher rate of spontaneous abortions. The clinical manifestations were correlated with the severity of the disease and were explained by the pelvic inflammatory response and oxidative stress. The pregnancy rate was lower in patients with endometriosis often due to exacerbation of the pathology. Conclusions. Endometriosis is one of the most common pathologies with a negative impact on female fertility. The IVF procedure in patients with endometriosis requires higher doses of gonadotropins and longer ovarian stimulation time

Tocolysis efficiency with Ca antagonists and inhibitors of prostoglands synthesis in premature pregnancy imminences

Catedra Obstetrică şi Ginecologie (Rezidenţiat) USMF „Nicolae Testemiţanu”Tempestuons pregnancy interruption represents a major problem in the modern obstetrics with a fugh influence on perinatal mortality indexes and infant morbidity. There are more groups of pharmacologic preparations with tocolytic aim: Mg therapy β-mimethics, the inhibitors of prostoglands synthesis, Ca antagonists. Our study consists in determination of efficiency of premature pregnancy imminences treatment with Ca blockers (Nifedipine) and inhibitors of prostoglands synthesis (Aspirine). Întreruperea intepestivă a sarcinii reprezintă o problemă majoră în obstetrica contemporană, influenţând mult indicii mortalităţii perinatale şi morbidităţii infantile. Sunt propuse mai multe grupe de preparate farmacologice cu scop terapeutic: terapia magnezială, β- mimeticile, inhibitorii sintezei prostoglandinelor, antagoniştii de Calciu. Studiul nostru constă în determinarea eficacităţii tratamentului iminenţei de naştere prematură cu blocatorii de Calciu (Nifedipina) şi inhibitorii sintezei prostoglandinelor (Aspirina)