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  • 1
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 10, No. 1 ( 2019-12-15), p. 101-106
    Abstract: The report presents two clinical observations of pregnancy outcome in patients with isthmic-cervical insufficiency of functional (first observation) and functional-organic (second observation) origin. In both cases, previously treated cervical erosion by laser (in the second observation – carried out excision of the cervix). In secundiparous women in the present pregnancy were noted recurrent urogenital (first observation) and genital (second observation) infection with a threatened miscarriage and the need for re-hospitalizations. Complex therapy with the introduction of obstetric discharge pessarium was not effective enough, there were manifestations of the inflammatory response of the body, isthmic-cervical insufficiency progressed, up to prolapse of the fetal bladder into the cervical canal (first observation). When entering the perinatal center, the treatment of pregnant women included methods of low-volume membrane plasmapheresis and photomodification of blood with ultraviolet and laser rays (alternated). In both cases, it was possible to stop the manifestations of inflammatory response, to improve the condition of the cervical canal, to prolong pregnancy to the term of normal childbirth. In the first observation, the birth occurred naturally, in the second case cesarean section was performed due to organic changes in the cervix. Childbirth, the postpartum period in women proceeded normally. Children were born healthy, full-term, develop normally, receive breastfeeding.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2019
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  • 2
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 14, No. 2 ( 2023-07-06), p. 5-16
    Abstract: BACKGROUND: To date, several options for helping pregnant women with rhesus immunization are known: (a) active tactics in carrying out methods of efferent therapy in the form of basic operations (plasmapheresis, hemosorption) in combination with adjuvant methods (immunoglobulin, blood photomodification with ultraviolet, laser beams, ozone therapy) to pregnant women; (b) wait-and-see active tactics with observation of the pregnant woman, followed by intrauterine intravascular transfusions of washed donor red blood cells; (c) mixed active tactics with a sequential combination, alternation of these methods. In Russia, only option 2 with fetal transfusions of washed donor red blood cells is accepted as the basis and paid for. The objective of the study is to conduct a comparative analysis of pregnancy outcomes in women with rhesus immunization using different management options. MATERIALS AND METHODS: A total of 392 women were followed up at seven different institutions in Russia and at the Donetsk Center for Maternal and Child Health (DNR), of whom 345 pregnant women (Group 1) received efferent therapy, 33 women (Group 2) had fetuses intrauterine bypass surgery, and 14 pregnant women (Group 3) had mixed efferent therapy and fetal PEEP bypass surgery. RESULTS: The analysis showed that the most favorable results for the main clinical indicators (premature, operative delivery, fetal hypoxia at birth, etc.) were in Group 1 and 3 women, in which the perinatal mortality was 14.5/1000 and 0/1000, respectively, which was significantly lower than in Group 2 (176.5/1000). It was also found that in Groups 2 and 3 women, the mean intervals between repeated transfusions of washed donor red blood cells were 8.8 0.2 and 21.4 3.8 days (p 0.01), which may be explained by the detoxifying effect of efferent therapy methods, preservation of fetal red blood cells and transfused donor red blood cells to the fetus with prolonged gestation and obtaining healthier and more viable progeny. CONCLUSIONS: 1. Severe Rh conflict is a manifestation of a syndrome of systemic effects of aggressive metabolites of specific and nonspecific nature. 2. The etiopathogenetic measure in the prevention and treatment of HDF/HDN in rhesus conflict is efferent therapy methods for the mother, and transfusion of washed donor rhesus-negative red blood cells to the fetus is effective, but a temporary, palliative measure, as is the case in multiple organ failure. 3. In the treatment protocols, efferent therapy methods must be present to prevent fetal red cell destruction and, equally importantly, to prevent destruction of Rh-negative donor red cells transfused to the fetus.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2023
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  • 3
    In: Pediatrics. Consilium Medicum, Consilium Medicum, , No. 1 ( 2022-05-10), p. 20-27
    Abstract: Aim. Assessment of the state of compensatory resources and the degree of adaptation of the body to environmental conditions in early and full-term infants in comparison with each other and with practically healthy children. Materials and methods. Under the supervision of 135 infants. 110 were born from mothers with a burdened somatic and obstetric-gynecological history, 41 of them were born at 3738 weeks (Group 1), 69 at 3942 weeks (Group 2). The control group (Group 3) consisted of 25 practically healthy children born to practically healthy mothers as a result of physiological pregnancies and childbirth at 3840 weeks. The children were examined in dynamics at the age of 1 (n=126), 3 (n=116), 6 (n=110), 12 (n=111) months. A comprehensive analysis of the data of anamnesis, physical examination, cardiointervalography was carried out. The following parameters were evaluated initially and in response to the tilt test: mode (М0), mode amplitude (AM0), delta x (∆Х), voltage index (IN). Nonparametric methods of statistical analysis were used. Results. At the age of 2 to 3 days infants born to women with a history of poor health recorded a significant decrease in the median IN1 value, respectively, in Groups 1, 2, and 3, which indicates a decrease in compensatory reserves, particularly in neonates born at 3840 weeks. At 1 month of age, Group 1 and 2 had higher median IN1 values of 804 and 746 versus 550 in Group 3, indicating the development of compensatory resource tension, particularly in children born at 3738 weeks. At 3 months of age, children in group 1 retained a compensatory tension of IN1 resources 521 versus 468 and 460 in groups 2 and 3. At 6 months of age, there is a slight decrease in compensatory IN1 reservers at 6 months of age in children from women with a history of a history of a history of a history of a disease 376 and 357 versus 400 in Group 3. At 12 months of age, children in the main groups have even more decreased compensatory resources, especially in group 1 IN1 206, 284 and 380 respectively in groups 1, 2 and 3. Conclusion. The decrease of functional reserve of adaptation in children of groups 1st and 2nd was facilitated by the influence burdened with somatic and obstetric-gynecological history of mothers, regardless of gestational age and subsequently the health characteristics of children themselves. The statistically significant differences found in the state of compensatory resources and the degree of adaptation of the organism to environmental conditions justify the personalized approach, which justifies a personalized approach when choosing rehabilitation measures.
    Type of Medium: Online Resource
    ISSN: 2658-6622 , 2658-6630
    Language: Unknown
    Publisher: Consilium Medicum
    Publication Date: 2022
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  • 4
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 11, No. 2 ( 2020-06-08), p. 5-14
    Abstract: According to the World Health Organization (WHO), viral diseases form serious public health problem. WHO announced that the disease caused by the new virus named coronavirus disease 2019 or Coronavirus disease 2019 (COVID-19), and the virus causing the infection was named SARS-Cov-2 by the International Committee on Taxonomy of Viruses. Children usually have asymptomatic or mild forms. However, children with comorbidity are in risk of developing severe forms of COVID-19. The review presents modern ideas about the amount of laboratory tests in cases of suspected presence of the SARS-CoV-2 virus, methods of radio diagnostic (computer tomography, x-ray, thorax ultrasound), features of the clinical course of infection in children depending on the severity of the of infection and indicated detailed criteria for severe forms of coronavirus infection. Special attention is focused on the clinical monitoring of children in a non-core hospital: the detection of leukopenia and lymphopenia, CRP level control, monitoring of coagulation disorders, providing tests on other respiratory viruses. Specific recommendations, comprehensive to date, on the use of drugs for the treatment of children with COVID-19 upon admission to a non-core hospital are given. The organisational issues of treatment children infected with COVID-19 in a non-core hospital are described in details. Special attention is focused on the compliance of strict safety rules by staff working with infected patients entering and leaving the Red zone. Thus, the proper organisation of the units for the treatment of children infected with COVID-19 in a non-core hospital, taking into account the features of their disease, will make it possible to provide complete and high-quality treatment of infection during the pandemic.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2020
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  • 5
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 13, No. 1 ( 2022-05-31), p. 35-42
    Abstract: Background: Dichorionic diamniotic twin pregnancy resulting from IVF can lead to isthmic-cervical insufficiency with concomitant complications. Against the background of the initial genital chronic infection in a woman there is a threat of septic complications for the mother-fetal couple. The complex pathology is accompanied by an accumulation of toxic substances in the mother-placenta-fetus system that requires pathogenetic treatment measures. Clinical Cases: This paper presents data on the results of efferent therapy in two pregnant women with dichorionic diamniotic twin pregnancy complicated by fetal bladder prolapsing into the cervical canal up to the external pharynx (1 case) and with premature amniotic fluid outflow of the first fetus (2 cases). The patients received preserving therapy at the hospital and then were transferred to the perinatal center with the clinical signs of threatening abortion, endotoxemia, and moderate inflammatory response, which were treated with efferent therapy in the form of medium-volume membrane plasmapheresis combined with photodilution with ultraviolet and laser beams. There were no complications during efferent therapy. In 1 and 2 observations the pregnancies of women in the perinatal center were prolonged by 45 and 34 days with operative delivery at 27 and 31 weeks, respectively. There were no septic complications in women and children. The newborn premature infants after therapeutic and rehabilitative measures had good prospects for a full life. Conclusion: The efferent therapy methods are safe and, in cases of IVF-infant foetuses with complicated isthmic-cervical insufficiency, are a pathogenetic measure; they help to prolong pregnancy and prevent infectious complications in the mother and fetus.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2022
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  • 6
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 12, No. 5 ( 2021-12-14), p. 79-83
    Abstract: The report presents the results of successful treatment of a married couple. A patient with multiple somatic pathology (varicose veins of the lower extremities, cholelithiasis, chronic cholecystitis) had 2 normal births in her first marriage. In the second marriage (the husband of 62 years revealed hypogonadism, cryptozoospermia, retrograde ejaculation) in 2018, ICSI was performed, which ended in an undeveloped pregnancy with curettage of the uterine cavity, in 2019, with the 4th pregnancy (CryoET), cesarean section (CS) at 28th week of pregnancy for chronic placental insufficiency with severe blood flow disorders in the placenta, nonimmune fetal dropsy. The child died on the 7th day of life. In 2020, due to the failure of the postoperative scar on the uterus after cesarean section, laparoscopy, hysteroscopy, and metroplasty were performed. The real, 5th pregnancy occurred after IVF with her husbands sperm taken from post-ejaculatory urine. At 39th week of pregnancy, a planned Сaesarean section was performed, a boy was born at 3710 gr, 52 cm long with an Apgar score of 8/9 points. There was no bleeding during childbirth, the patients postoperative period was smooth. She was discharged home on the 5th day after delivery in a satisfactory condition with normal tests with a baby receiving breastfeeding.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2021
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  • 7
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 13, No. 4 ( 2022-11-27), p. 93-100
    Abstract: It is known from the literature that premature amniotic fluid expulsion in 22 weeks 27 weeks 6 days gestation is very dangerous, as it is accompanied by high morbidity and mortality in newborn infants. Clinical observation. This article presents the results of observing two women with premature amniotic fluid expulsion at 22 and 24 weeks gestation, respectively. In the first case, the woman was immediately admitted to the perinatal center; in the second observation, she was admitted after 3.5 weeks of treatment at another institution. In both cases, pregnant women had manifestations of oligo and endotoxemia, a protective inflammatory response in the mother-placental-fetal system (more pronounced in the second observation) against a background of urogenital infection. In the course of complex treatment, the patients underwent detoxification, of efferent therapy in the form of repeated consecutive sessions of plasmapheresis, hemosorption (one operation each), external photomodification of blood with ultraviolet, laser beams with prolongation of pregnancy by 10 and 8 weeks. The deliveries in both cases were operative with live babies with body weight of 1600 g and 1840 g, respectively. In the first case the infant did not need intensive care, was breastfed, in the second observation the newborn received active respiratory support for 9 days, in the dynamics his condition normalized. No septic complications in mothers and fetuses were observed. The concluding efferent therapy in course of therapy were effected by prolongating of pregnancy with of good the results for mothers and them of fetus.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2022
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  • 8
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 10, No. 5 ( 2020-01-28), p. 101-104
    Abstract: In the article presents data on the management of a 48-year-old patient with HIV infection, urogenital infection with pregnancy, which occurred as a result of IVF, with premature effusion of amniotic fluid at 23 weeks of pregnancy with the syndrome of growth retardation of 2 fetus in monochoric diamniotic twins. After the discharge of the amniotic fluid, the patient was treated for six days in an infectious hospital, then transferred to the perinatal center, where blood tests noted moderatemanifestations of endotoxicosis, increased levels of aminotransferases and an inflammatory reaction of the body. The course of treatment included detoxification methods (plasmapheresis, hemosorption, photomodification of blood with ultraviolet, laser rays), which contributed to the normalization of blood tests, prolongation of pregnancy for another three weeks in the absence of septic complications after operative childbirth in the mother and in newborn girls. At birth, 1 childs weight, body length and Apgar score were 750 g., 29 sm. and3/5points, respectively, in 2 children 590 g., 30 sm. and1/3points, respectively. The children required treatment from resuscitators, at the second stage of nursing, from rehabilitation specialists.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2020
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  • 9
    Online Resource
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    ECO-Vector LLC ; 2022
    In:  Pediatrician (St. Petersburg) Vol. 13, No. 1 ( 2022-05-31), p. 5-18
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 13, No. 1 ( 2022-05-31), p. 5-18
    Abstract: Population reproduction is a priority task of social policy and a factor of Russias national security. The review presents the stages of recording the perinatal mortality indicator, which is closely related to the frequency of preterm birth. In the first stage, the criteria for registering preterm birth were 28 weeks of pregnancy, and in the second, since 2012, 22 weeks. At both stages, due to underreporting of low birth weight babies (their transfer to the miscarriage group), stillbirths, including full-term babies, prevailed in the preterm birth indicator structure. The authors of the article stressed that the main cause of preterm birth (including iatrogenic) is the formation of endotoxemia syndrome, or systemic effects of aggressive metabolites in the mother placenta fetus system. In this etiopathogenetic therapeutic means are methods of efferent therapy in the form of plasmapheresis, etc. These technologies in many obstetric pathologies (thrombophilia, preeclampsia, Rh-conflict, isthmic-cesmic and chronic placental insufficiency, etc.) sanitize the mother placenta fetus system and allow to prolong pregnancy with a reduction of perinatal mortality index. The authors cite their own data on the use of efferent therapy methods in 102 women presenting at 2228 weeks of pregnancy to the Perinatal Center of Saint Petersburg State Medical University from other institutions after unsuccessful treatment according to the Protocols for various obstetric complications. Pregnancies were prolonged by 215 weeks; all 123 children (20 twins, 1 triplet) were born alive, did not require long-term intensive care, survived and were not disabled. Six newborns died and the perinatal mortality rate was 48 : 1000, which is an order of magnitude lower than that quoted in the literature for similar pathologies and gestational ages. In conclusion of the article, it is suggested that in order to reduce perinatal mortality in Russia, all large institutions should arrange efferent therapy rooms to treat sick pregnant women using the safe, low-cost technologies developed by the authors, using domestic equipment.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2022
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  • 10
    In: Pediatrician (St. Petersburg), ECO-Vector LLC, Vol. 10, No. 2 ( 2019-06-19), p. 111-120
    Abstract: The article presents three clinical observations of successful conservative treatment of pregnant women with monochorionic, diamniotic twins (MDT), coming naturally. In all cases, there were manifestations of twin-to-twin transfusion syndrome (TTTS) with progressive blood flow disorders in the utero-placental space with a pronounced delay in the development of one of the fetuses. In the early stages of pregnancy was supposed to terminate the pregnancy, but the women refused. Pregnant women were admitted to the perinatal center at 23, 23 and 24-25 weeks, respectively. During the examination, the diagnosis was confirmed, at the same time in all cases, the patients found manifestations of endotoxicosis and inflammatory response. Pregnant conducted methods of detoxicational (efferent) therapy in the form of photomodification of blood with sessions of laser and ultraviolet radiation in combination: in the first case — plasmaexchange with 5% albumin solution No 6 and the cascading plasmafiltration No 5; in the second observation - with medium volume plasmapheresis No 7, hemosorption No 1; in the 3rd observation – with plasmapheresis No 7, hemosorption No 3. Complications at efferent therapy was not, indices of homeostasis of pregnant women in the dynamics normalized. Blood flow disorders in the placenta persisted, but there was a steady increase in body weight of the fetus. In general, women’s pregnancies were prolonged for 11, 13 and 9 weeks, respectively (in the first two cases, women were even temporarily discharged home). Childbirths in all cases were performed by operational pathway, there were no complications in childbirth and after childbirth in mothers. All six children were born alive with mild and moderate prematurity and did not need long-term intensive care. All were on breast-feeding, in dynamics surveillance caught up with contemporaries in development.
    Type of Medium: Online Resource
    ISSN: 2587-6252 , 2079-7850
    Language: Unknown
    Publisher: ECO-Vector LLC
    Publication Date: 2019
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