HEALTH OF WOMAN WH_№5_2012
Pirogova V. I., Shurpyak S. О., Misiura А. G.
Сanephron N in the prevention of obstetric and perinatal complications in diseases of the urinary tract in pregnancy.
The article touched the questions the study belonging to the therapy methods of kidney diseases at pregnant women. The 70 pregnant women with infections of kidney in anamnesis and 60 pregnant women with non-symptoms bacteriuria are inspected; they got Canephron N (1 drage/3 times per day during 1 month). It is shown that patients passing traditional antibiotic therapy convalesced in more protracted terms, had more slow normalization of clinic-laboratory indexes of flow of disease, by-reactions and undesirable gestational complications, less protracted period of remission by compared to women who got Canephron N. Therefore Canephron N can serve as preparation of choice at treatment of expectant mothers with different disorders of the kidney system.
Key words: pregnancy, kidney diseases, therapy, Canephron N.
«Перинатальная медицина: от семейной амбулатории до частной клиники». Обзор Первого международного конгресса по перинаталь-ной медицине.
Nazarenko L., Semerinskaya I.
Mechanisms of formation cord twist around fetus.
Purpose – to clarify the frequency of children born with umbilical cord entanglement in relation to helio-bio-logical factors and determine the relation of individual characteristics and parameters of placenta with um-bilical cord twist around fetus. Inverse relationship was found cyclical changes in solar activity with the frequency of umbilical cord entanglement. It is shown that entanglement umbilical cord and placenta blood vessels excessive coiling give cumulative effect that causes a high risk of violation of feto-placental communications.
Key words: umbilical cord entanglement, spiralizatsiya, solar activity.
Рудакова Е. Б.
Папилломавирусная инфекция и влагалищный микробиоценоз.
Ключевые слова: папилломавирусная инфекция, влагалищный микробиоценоз, цервикальная интраэпителиальная неоплазия, рак матки, вирус папилломы человека, риск инфицирования, вто-ричные иммунодефициты, канцерогенез, иммунитет, иммуномодулятор.
Nazarenko L., Sorokolat Yu.
In utero programming obstetric pathology in offspring: the arguments and facts.
The review of data that reveal the nature and mechanisms of fetal programming of disease in offspring, the arguments in favor of influence of perinatal development of women to form in her pregnancy pathology (placental dysfunction, severe preeclampsia, placental abruption, preterm labor, gestational diabetes).
Key words: рrogramming, fetus, delayed development, disease descendants.
Сумская Г. Ф., Фомичева С. В.
Железодефицитные состояния у беременных.
Писаренко А. Ф., Писаренко И. А., Федусенко А. А., Семенцов А. С., Луценко Н. С., Евтерева И. Н., Гераскина Л. Р.
Повышение эффективности радикального лечения предраковых за-болеваний шейки матки у женщин, инфицированных вирусом папи-лломы человека.
В статье представлены результаты изучения эффективности и безопасности лечения предопухоле-вых процессов шейки матки на фоне инфицирования ВПЧ Лавомаксом и радиохирургическим воз-действием по сравнению с лафаробионом и тем же радиохирургическим методом. Достигнута поло-жительная динамика цитологических, кольпоскопических показателей, а также безрецидивность в течение 6 мес в 80,7% и 77,2% случаев. Отмечена хорошая переносимость и безопасность лавомак-са.
Ключевые слова: преопухолевая патология шейки матки, папилломавирусная инфекция, лечение.
Veropotvelyan P. N., Leuch S. S., Veropotvelyan N. P., Guzhevskaya I. V.
A modern view on genital prolapse.
An overview of literature on genital prolapse (GP) which dysfunction is conditioned by prevalence is made. The article includes data on etiology and pathogenesis as well as own investigations of GP in 117 patients. The data of the literature show that the mechanical properties of the connective tissue such as solidity, ela-sticity, neurotic changes of thee muscles in pelvis bottom remain uncleared up.
Key words: genital prolapse, the elasticity of tissue.
Boris E. N., Sumenko V. V., Malysheva I. V., Onishchik L. N.
Conservative treatment of uterine fibroids with simple nonatypical endo-metrial hyperplasia.
The article shows the effectiveness and ease of use of the drug of natural origin Miomin in the treatment of uterine fibroids, combined with simple nonatypical endometrial hyperplasia. Shows a positive trend in redu-cing the symptoms of the disease, ease of use and good tolerability. Showing regressive changes in the treatment process. The expediency of the proposed treatment regimen.
Key words: uterine fibroids, endometrial hyperplasia, a drug of natural origin Miomin, hyperestrogenia.
Vovk I. B., Kondratiuk V. K., Trohimovych O. V., Kovalenko A. I.
Threat of interruption of pregnancy in early terms: modern views on an etiology, pathogenesis, diagnostics and treatment (the literature revi-ew).
In article are submitted data concerning epidemiology and risk factors of development of threat of interruption of pregnancy. Modern principles of diagnostics and new approaches to treatment of threat of interruption of pregnancy are highlighted.
Key words: threat of interruption of pregnancy, early reproductive losses.
Дуда А. К., Бойко В. А.
Болезнь Вильсона и беременность (клиническая лекция).
В лекции представлены клинические, эпидемиологические данные и сведения о патогенезе болезни Вильсона – редкого наследственного заболевание с аутосомно-рецессивным типом наследования. Приведены данные о диагностике и лечении, в том числе беременных.
Ключевые слова: болезнь Вильсона, клиника, диагностика, лечение, лечение болезни Вильсона у беременных.
Американский колледж акушеров и гинекологов.
Рекомендации по антибиотикопрофилактике в гинекологии.
Grek L. P., Ushakova T. B., Lazurchenko Ya. V.
Optimizing the treatment of patients with infectious vulvovaginitis clinic urgent gynecology.
The retrospective analysis of 60 hospital chart, patients with vulvovaginal infection is lead. Comparative ef-ficiency and bearableness of complex use of’ therapy Zalain and Betadine (Egis, Hungary), absence of re-lapse vaginal infection and vaginal microbial environment normalized.
Key words: vulvovaginal, Zalain, Betadine.
Leshcheva T. V., Vasilenko T. V.
Tactics of conducting women with inflammatory processes of genitals and an acute appendicitis.
Results of the spent researches confirm an urgency of the chosen scientific problem – a combination of infla-mmatory diseases of bodies of reproductive system of an acute appendicitis. Use of offered algorithm allows to raise efficiency of diagnostics of the given pathology, and also to lower frequency of postoperative compli-cations. It allows to recommend the developed algorithm for wide use in practical public health services.
Key words: inflammatory processes of genitals, an acute appendicitis.
Pyrohova V., Litvinyuk S., Veresnyuk N.
Strategy and tactic at herpes-virus deviations of reproductive system.
As a result of research expedience of application of the differentiated going is well-proven near treatment of women with infecting of HSV-II. It is set that for women with genesial violations frequency of asymptomatic selection of HSV-II is 13.7% and in 14.9% there are clinical episodes of genital herpes, with frequency of relapses from 4 to 10 for a year. Application antiviral mean of Heviran (acyclovir) in a dosage 800 mgs one time in days clinically and laboratory effectively and promotes complaence of patients to the lead through either episodic or suppressive antiviral therapy.
Key words: reproductive health, herpes simplex virus, antiviral therapy, Heviran, acyclovir.
Zaporozhan V. N., Trushkevich A. A.
Rehabilitation of reproductive function of women at various hyperprolac-tinaemia.
Use of offered algorithm of diagnostic and treatment-and-prophylactic actions with micro- and macroadeno-mas allows to achieve stable restoration from women of reproductive age menstrual function to 80%; redu-ction of clinical displays mastodania and mastalgia (on 30% and 28%), and also decrease galactorea; nor-malisation of indicators of the general prolactinum and reduction to percentage its warehouse “little” – frac-tions to 70%, and also the basic hormonal indicators and a condition visual analizator at simultaneous res-toration of peripheral fields of vision; restoration of reproductive function in 50% of cases. The received re-sults allow to recommend the developed algorithm for wide use in practical public health services.
Key words: hyperprolactinaemia, reproductive function, rehabilitation.
Leshcheva T. V., Prokopenko E. P.
Tactics of conducting patients with an endometriosis against chronic inflammatory diseases of reproductive system.
On the basis of the executed clinical-laboratory and functional researches we had been improved and intro-duced algorithm of diagnostic, treatment-and-prophylactic and rehabilitation actions on conducting patients with complex pathology of genitals which includes genital endometriosis and inflammatory diseases. The received results allow to recommend its wide use in practical public health services.
Key words: genital endometriosis, inflammatory diseases of genitals, conducting tactics.
Chechuga S. B., Nochvina E. A., Sali Abdallah
Pathogenetic therapy of miscarriage in women withhyperhomocysteine-mia and progestogen deficiency.
The article presents data on the effectiveness of treatment regimens designed miscarriage in the first tri-mester when hormone deficiency on the background of hyperhomocysteinemia. Powered pathogenetic
substantiation of prescribing, traces dynamics of development and pregnancy.
Payenok A. S., Tsipkun A. G., Kostiv M. A.
Correction of nitric oxide metabolism and nucleic acid homeostasis in pregnant women with thyroid gland pathologies.
160 pregnant women with various forms of thyroid gland pathologies and 20 women with physiological co-urse of gestation were observed. For treatment of 80 pregnant women was used a traditional therapy of pregnancy complications, which were caused by diseases of the thyroid gland. Results of treatment of this group were compared with the effect of Cytoflavin and Glutargin according to parameters of nitric oxide me-tabolism and nucleic acid homeostasis. Suggested therapy promoted metabolism improvement of maternal-fetal complex, increased the level of L-arginine and decreased activity of nucleases.
Key words: pregnancy, thyroid gland pathology, L-arginine, nucleic acids, nucleases, Cytoflavin, Glutargin.
Marichereda V. G.
Change in serum leptin levels and lipid profile in preeclampsia.
Despite the fact that the underlying mechanisms of preeclampsia is not completely clear, endothelial dys-function is the cause of many manifestations of preeclampsia. As one of the factors predisposing to the development of endothelial dysfunction, consider an abnormal increase in serum leptin levels as a result of hypoxic changes in the placenta and mediated lipid metabolism. The aim of this study was to identify the relationship between leptin levels and changes in lipid profile of pregnant women with preeclampsia and to evaluate the role of atherogenic factors in the pathophysiology, early diagnosis and prediction of preeclam-psia. Materials and Methods: This study included 267 patients, of which 172 pregnant women with preeclam-psia composed the main group and 95 with uncomplicated pregnancy – control group. All pregnant women were compatible for age, gestational term, height and weight. Leptin levels in serum were determined by ELISA, the overall lipid profile – enzymatic colorimetric method.
Results: Serum leptin levels were significantly elevated in patients with preeclampsia (p<0.05). Ranked among the lipid profile in a group of pre-eclampsia found increased only in relation to triglycerides (p<0.05) in subgroups with severe and mild pre-eclampsia. Strong correlation between serum leptin levels and triglyceri-des in the study group (r=0,71) was revealed. Conclusions: The study showed that serum leptin levels in pre-eclampsia are closely linked to the level of triglycerides, whereas the correlation with other components of the lipid profile is negligible. The severity of preeclampsia is increased in proportion to the level of leptin and triglycerides. These changes may represent the step of pathogenesis of preeclampsia and the cause of athe rogenic complications in women who have had preeclampsia in the late postpartum period.
Key words: leptin, preeclampsia.
Шурпяк С. О.
Прогностичні маркери невиношування вагітності у жінок із синдро-мом втрати плода
Встановлено як для фізіологічній вагітності, так і для вагітності, яка ускладнена загрозою невиношу-вання, що характерним є зниження сироваткового рівня глікоделіну. Проте в пацієнток з обтяженим анамнезом щодо втрати плода в разі загрози переривання вагітності виявляється рання виражена зворотна динаміка вмісту глікоделіну, який здійснює локальне пригнічення імунної відповіді матері на ембріон і плід, призводить у різні терміни вагітності до її завмирання або втрати. Отримані дані свід-чать про значні зміни в продукції біоактивного поліпептиду глікоделіну з І триместру вагітності, усклад-еної загрозою переривання. Пацієнткам із синдромом втрати плода слід рекомендувати визначення рівня глікоделіну в сироватці крові з моменту встановлення факту вагітності для проведення адекват-них і, головне, своєчасних заходів, спрямованих на виношування вагітності.
Ключові слова: вагітніcть, синдром втрати плода, невиношування вагітності, глікоделін.
Avramenko T. V., Goncharenko N. I., Kolomiichenko T. V., Saar M. Yanuta
Function study of the endothelium condition for pregnants with arterial hypertension.
According to ultrasound study among 104 pregnants with chronic arterial hypertension ascertained the incre-asing of brachial artery diameter with the reactive hyperemia less for 10%, increasing the index of peripheral vessel resistance (for 10,4 and 26,7% according to the I and II stage disease), thickening of the complex of intimamedia of carotid artery. Such changes indicate to the availability of endothelium dysfunction for preg-nants with arterial hypertension, which brings to the development of obstetrics and perinatal complications.
Key words: pregnancy, arterial hypertension , endothelium dysfunction, ultrasound study.
Ramazanov V. V., Golyanovskyy O. V., Radzikhovskyy V. P.
Comparative analysis instrumental and calculation methods for deter-ming hemodynamic profile in pregnant women with arterial hypertension.
A comparative study of the reliability of the instrument and the calculation methods for determining the hemo-dynamic profile in pregnant women with hypertension. Reliably established the high degree of correlation controlled hemodynamic parameters using both methods and feasibility of clinical application of the calcula-tion method, buyout allows selective (selective) antihypertensive therapy.
Key words: pregnancy, hypertension, hemodynamic profile, methods of determination, pre-eclampsia.
Podolsky Vl. V.
Menstrual dysfunction on a background of chronic inflammatory dise-ases of the genital organs in women of childbearing age and their cor-rection.
Information about clinical-epidemiological, ultrasonic, dopplerometical, histological researches in violations of menstrual function on a background of chronic pelvic inflammatory diseases for the womenof fertile age is presented in the article. Dependence of changes, that are taking place in the organs of the female reproduc-tive system from the level of inflammation and from the term of manifestation of symtoms after treatment in anamnesis is analysed. The most frequent types of violations of menstrual cycle are found for women with chronic pelvic inflammatory diseases. The exposed changes allow asserting, that an inflammatory process in the organs of the reproductive system results in changes of microcirculation which, in same queue dimini-shes possibilities of correction of hormonal violations, which is taking place for women with chronic pelvic inflammatory diseases. The method of correction of violations of microcirculation is offered for women with chronic pelvic inflammatory diseases.
Key words: chronic pelvic inflammatory diseases, violations of menstrual function, hormonal homeostasis, violations of microcirculation, endometium, hemodynamics.
Benyuk V. O., Nikonyuk T. R.
Clinical experiment of nonspecific bacterial vaginitis treatment using antibacterial medicin Gepacef combi.
Results of the lead (the carried out) researches testify, that combined use of preparat Gepacef combi shows an acute therapeutic effect in curing of nonspecific bacterial vaginitis against the background of the given therapy. Besides in practice the preparat are easy to use, show a good tolerance and do not cause any aller-gic reactions. It allows recommending Gepacef combi wide use for the treatment of nonspecific bacterial vaginitis.
Key words: nonspecific bacterial vaginitis, a mixt-infection, inflammatory diseases of genitals, treatment.
Vdovychenko J. P., Volosovsky P. R.
Reproductive health of women after extra-uterine pregnancy.
Results of the spent researches testify to a high urgency of a studied scientific problem – reproductive health of women after extra-uterine pregnancy. The algorithm of diagnostic, treatment-and-prophylactic and rehabi-litation actions improved by us allows to raise efficiency of diagnostics of the given pathology, in due time to spend operative treatment with optimum volume, to lower frequency of the early remote postoperative com-plications, to restore reproductive function of patients and to improve obstetrical and perinatal outcomes of delivery. The received results are the basis for wide introduction of advanced algorithm in practical public health services.
Key words: extra-uterine pregnancy, reproductive health.
Syhanova A. A., Gopchuk E. N.
Inflammatory diseases of pelvic organsю Dicloberl – therapeutic effi-ciency.
Information about efficiency and safety of application of nonsteroid antiinflammatory preparation Dicloberl (rectal suppositories) in the complex of treatment of patients with inflammatory diseases of small pelvis or-gans in ambulatory terms is brought over in the article. Research confirmed efficiency and safety of prepa-ration Dikloberl. A wide therapeutic spectrum allows to recommend him to application in composition com-plex therapy for patients with intensifying of inflammatory diseases of organs of small pelvis both in ambu-latory and in stationary terms.
Key words: are inflammatory diseases of organs of small pelvis, natrium diclophenac, Dicloberl, treatment.
Дубенко О. Д.
Особливості стану молочних залоз у жінок з нереалізованою вагіт-ністю в анамнезі.
Zaporozhan V. M., Polyakova Y. A.
Molecular-genetical determinants of PCOS.
The study was aimed to assess the prevalence of functional polymorphism of the genes of xenobiotic deto-xycation system (GSTM1, GSTT1 and CYP19), PPARG2, FTO amongst females suffering PCOS. There was demonstrated that the risk of PCOS occurrence is increases in 3.7 folds (OR=3,7; CІ 95% 2,8; 4,9) amongst females with GSTM1 0/0 genotype. The combination of deletions by the genes GSTM1 and GSTT1 – in 34.5 folds (OR=34,5; CІ 95% 20,1; 59,4). There was determined the homozygote genotype GG PPARG2 (rs1801282) increases the risk of PCOS occurrence in three folds (OR=3,2; CІ 95% 1,8; 5,6). The average number of the repeats of (CAG)n triplets in the exon 1 of AR gene in the control group was 20±0,4, and in the group of PCOS patients – 19,4±0,5 (p>0,05). There was found the strong negative correlation between the functional polimorphism by gene CYP19 (rs12907866) and the level of hyperadrogeny amongst females with PCOS. The presence of functional polymorphisms by PPARG and FTO genes does not impact on the number of CAG repeats in the AR gene and on the hormonal profile of the patients with PCOS. There was discussed the possibility of the use of the functional polymorphisms of genes associated with the risk of PCOS for choosing the scheme of the treatment of this pathology.
Key words: polycystic ovarian syndrome, genetics, diagnosis, prognosis.
Negrebetskaja J. M.
Forecasting and early diagnostics of a pathology of mammary glands at women with genital endometriosis.
Results of the spent researches have shown, that the scientific problem of increase of efficiency of diagno-stics and treatment of a good-quality pathology of mammary glands against genital endometriosis is enough actual and demands the individualised complex campaign with the account data additional methods of rese-arch. The offered algorithm allows to raise efficiency of diagnostics and treatment given complex pathologies and to lower disease of women of reproductive age.
Key words: genital endometriosis, a pathology of mammary glands, diagnostics, forecasting.
Shcherbina N. A., Kartashova M. A.
Influence of microsatellite instability аndmethylation of gene ESR on efficiency of application hormonotherapy at patients with endometrial hyperplasia.
At 83 patients with endometrial hyperplasia (EH) without atypia efficiency of application hormonotherapy depending on age, presence of microsatellite instability (MSI) and methylation of gene ESR is studied. It is shown that efficiency standard hormonotherapy decreases with increase in age of patients, and presence MSI or methylation of gene ESR authentically increase frequency of relapses EH.
Key words: endometrial hyperplasia , microsatellite instability (MSI), gene ESR, clinical presentations, hormonotherapy.
Kukurudz S. M.
Tactics of carrying out auxiliary reproductive technologies at patients after the transferred operations on uterus appendages.
Results of the spent researches testify, that patients after operative interventions on bodies of reproductive system should be directed on consultation of the doctor-reproduktologist to specialised branch to estimate their reproductive function and, in case of need, to develop effective methods of conducting such women for the purpose of restoration fertility in optimum terms. The advanced technique of auxiliary reproductive tech-nologies at these patients allows to lower frequency of female barreness and to raise efficiency of approach of desired pregnancy.
Key words: operations on uterus appendages, auxiliary reproductive technologies.
Prudnikov P. M.
Diagnostics and tactics of surgical treatment complex pathologies of a uterus and ovariums.
Results of the spent researches testify to an urgency of a studied scientific problem – complex pathology of a uterus and ovariums. The developed algorithm of diagnostic, treatment-and-prophylactic and rehabilitation actions allows to raise efficiency of operative treatment, and at desire of patients and absence of contra-indications – to restore reproductive function.
Key words: complex pathology of a uterus and ovariums, diagnostics, surgical treatment.
Zhuk S. I., Taran O. A., Koshmerynska A. N.
Modern approaches to the diagnosis and treatment of cervical neoplasia associated with papillomavirus infection.
The present examinations indicate the presence of disorders of local immune reactions caused by an imba-lance of cytokine production associated with infectious lesions of the cervix within patients with cervical neoplasia. Inclusion in the scheme of treatment of Allokin-alpha preparation for such patients contributes to the restoration of proinflammatory cytokine status, thereby increasing the anti-virus protection, that allows accelerate the healing process, reduce the number of relapses and lead to convalescence.
Key words: cervical neoplasia, human papilloma virus, cytokines status, Allokin-alpha.
Дубоссарская З. М.
Программа профилактики перинатальной патологии при инфекцион-ных заболеваниях урогенитального тракта у супружеских пар.
Evstigneyeva N. P., Kuznetsova YU. N., Rakhmatulina M. R., Mikhailova O. O.
Management of patients with inflammatory urogenital tract diseases associated with M. hominis.
Based on the published data, the authors present an algorithm for examining the patients suspected of ha-ving infectious diseases of the urogenital tract (UGT). The examination of 59 women with inflammatory UGT diseases associated with M. hominis has established that a differential approach to treating and following up is shown in such patients depending on the species and diagnostic titer of the pathogen, its susceptibility to antibacterial agents, the presence/absence of mutations in the 16S ribosomal RNA gene of the M. hominis strain.
Key words: urogenital mycoplasma, inflammatory diseases of the urogenital tract, differential approach to treatment.
Kaminskyy V. V., Shypkо I. M.
Features pregnancy and childbirth in women with herpes virus and cy-tomegalovirus infection after use of assisted reproductive technologies.
Analyzed anamnestic data, the results of serological examination, especially during pregnancy, childbirth, postpartum, fetal and newborn in women with herpes virus and cytomegalovirus infection after use of assisted reproductive technologies. The use of specific treatment allowed to reduce the frequency of obs-tetric and perinatal complications in this contingent of women.
Key words: cytomegalovirus infection, genital herpes, pregnancy, miscarriage, childbirth, baby, newborn, assisted reproductive technology.
Булавенко О. В., Льовкіна О. Л.
Особливості гормонального гомеостазу в жінок раннього репроду-ктивного віку зі стрес-індукованим безпліддям.
Виявлені значні порушення гормонального гомеостазу в жінок раннього репродуктивного віку зі стрес-індукованим безпліддям, в яких виявлено значне підвищення рівня сироваткового кортизолу та про-лактину, та зниження рівнів ФСГ, ЛГ та прогестерону, що вказує на гіперактивацію стрес-реалізуючої системи і пов’язані із цим порушення репродуктивного здоров’я жінки.
Ключові слова: стрес, безпліддя, гормональний гомеостаз.
Zaharenko O. S., Yuzko O. M., Zaharenko L. V.
Role antymyulerovoho hormone in the evaluation of ovarian reserve in infertility associated with small forms of endometriosis.
The paper presents the findings pertaining to hormonal homeostasis in women with sterility in case of ex-ernal genital edometriosis. The results of the investigations carried out by the author are indicative of a negative influence of genital endometriosis on the state of the reproductive health of women.
Key words: genital endometriosis, sterility, reproductive function.
Veropotvelyan P. N., Guzhevskaya I. V., Veropotvelyan N. P.
Endometriosis in patients with a deferred pregnancy who suffer from sterility.
On the basis of the literature data and own investigations possible causes of sterility development in patients with a deferred pregnancy on the background of endometriosis are underlined. The determinant factor is the woman’s age, ovarian reserve, the duration of sterility, anatomo-functional state of the Fallopian tubes and the results of spermagramma. In case of impossibility of the natural conception with unsatisfactory results of the sperm investigation or the presence of the tube factor an immediate performance of VPT is recommen-ded.
Key words: endometriosis, sterility.
Vulvar cancer: optimizing the use of modern techniques for diagnosis of pathologies of female external genitalia.
According to different sources, in 30–50–75% of all cases the tumor, when found, has already progressed to the 3rd or 4th stage, which makes adequate treatment impossible or extremely challenging. The article offers a set of diagnostic measures for diagnosis of pathologies of female external genitalia at any development stage, as well as for the patient follow-up after the treatment. The article recommends a screening program, aimed at timely diagnostics of carcinomas and precancerous diseases vulva, for timely diagnosis of patholo-gies of female external genitalia.
Key words: vulvar intraepithelial neoplasia, cancer, diagnostics, vulva.
Кесарево сечение: из мифов – повседневную практику.