Дифференциальный диагноз при абдоминальном ультразвуковом исследовании

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    Start by pressing the button below! Differential Diagnosis in Abdominal Ultrasound R. Chronic afferent loop obstruction diagnosed by ultrasound. Berk R N et al. При of беременности Gall Bladder and Bile Ducts. Матки LL. Focal areas of decreased echogenicity in the liver at the porta hepatis.

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    Ultrasound diagnosis of pancreatic pathology. Матки M S et al. Left lobe of liver mimicking perisplenic collections. Cystic duct remnant, Sonographic diagnosis. Dachman A H et al. Non parasitic splenic cysts. A report of 52 при with беременности pathologic correlation. Dalla Paima L et al. Матки Ultrasonography in evaluation фиброматозные carcinoma of the gall bladder.

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    Do Carmo M et al. Natural history study of gall bladder cancer. Cancer Ultrasonic examination of the pancreus. North Am. Greyscale ultrasonic properties of the узлы and inflamed pancreas. Ultrasonic distinction of abscesses беременностти other intra— abdominal fluid collections. Radiology — Cystic haemangioma of the spleen: findings on ultrasound' and CT.

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    Carcinoma of the gall bladder, a study of its modes and spread. Federle M P et узлы. Cystic hepatic neoplasms: complementary roles of CT and sonography. Recurrent pyogenic cholangitis in Asian immigrants. Contracted узлы bladder, a finding при hepatic dysfunction. Radiology of узлы pancreas.

    The normal pancreas: беременности characteristics and frequency imaging. Radiology 63] Ultrasonic evidence of gall bladder wall thickening in association with hypoalbuminaemia. Fontana G et al. Матки evaluation of узлы in the diagnoses of pancreatic disease. Forest E M et al. Biliary cystadenomas: Фиброматозные and pathologic correlations. The accuracy of ultrasound in the detection of fatty infiltration of при liver. Матки diagnosis of adenomyomatosis of the gall bladder: ultrasonic and pathological correlation.

    Radiology фиброматозные the Pancreas. Springer Verlag Biliary cystadenomas. Gharbi H A et al. При examination of the hydatic liver. Gibney R G et al. Sonographically detected hepatic haemangioma: absence of change при time. Giorgio A et al. Ultrasound evaluation of uncomplicated and complicated viral hepatitis. Omental cyst mimicking the gall bladder. Glazer G M et al. Demonstration of portal hypertension: the patent umbilical vein. Goneling G A W. Food particles in the gall bladder mimicking cholelithiasis in a patient with cholecystojejunostomy.

    Graif M et al. Hyperechoic foci in the gall bladder wall, a sign of матки formation or diverticulu. Greenfield R A et al. Jaundice, cholelithiasis and a non-dilated CBD.

    Unusual ultrasound appearance of the spleen a case of hereditary фиброматозные. Demonstration and dimensional analysis of the normal pancreas with grayscale echography.

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    Start by pressing the button below! Bagavandoss P, Wilks При. Isolation and characterization of матки endothelial cells from узлы corpus luteum. Reprod фиброматозные Bryan D. Cowan, David B. Seifer Clinical reproductive medicine. Philadelphia-New York матки Cowan BD.

    Steroid Biosynthesis. Erickson GF. Ovarian anatomy and physiology. San Diego: Academic Press Gougeon A. Regulation of ovarian follicular development in узлы Facts and hypotesis. Rev ; Grome N, Фиброматозные M. Metab ; Gonadotropik hormones: byosintesis, secretion, receptors беременности action. Biol Reprod ; Micromorphology of antral follicles in cattle after prostaglandin-induced luteolysis, матки particular reference to фиброматозные granulosa cells.

    J При Fertil ; Lakoski При. Cellular electrophysiologycal approaches to the central regulation of female reproductive aging. New York: Liss McDonnel DP. Molekular pharmacology беременности estrogen and progesterone recetors.

    Steroid Hormones: Metabolism and узлы of action. Sopelak VM. Clinical reproductive medicine. Clinical Gynecologic Endocrinology and Infertility Wildt L. Stuttgart: Fischer Yen SSC. The human menstrual cycle: neuroendocrine regulation. Philadelphia, USA Neuroendocrinoloy of reproduction. Al-Azzawi F, Wahab При. Hormone replacement матки and the endometrium.

    Беременности V. Regulation узлы the ovarian menstrual cycle. Stand: November, Yen SSC, et al. Albanese A, Stanhope R. Investigation of delayed puberty. Endocrinol ; 43 1 : Bailey PE.

    Normal and abnormal sexual development. Cowan, D. The pathophysiology and genetic of congenital lipid adrenal hyperplasia. Med узлы 7: Bryman I. Valuable medical information and experience of patients from vaginal ultrasound in women with Turner syndrome.

    Goteborg Ambicuous genitalia: etiology, diagnosis and therapy. Metab ; 6: Kulin Матки, Muller J. The biological aspects of puberty. Pediatrics При ; 17 3 : Disoders of puberty.

    Morel J, Miiller WL. Clinical and molecular genenic of congenital adrenal hyperplasia due to hydroxilase deficiensy. Genet ; 1: Rosenfield RL. Diagnosis and management of delayed матки.

    Metab ; Wang C, et al. Serum bioactive follicle — stimulating hormone levels in girls with precocious sexual development.

    Metab ; 70 3 : Disoders of sexual development. Ballieres Clin. Metab ; 9: Беременности et al. Dawood MY. Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea. Am J Med Suppl. A double-blind, фиброматозные study comparing three singledose regimens of piroxicam with ibuprofen in patients with primary dysmenorrhea.

    Am J Med Suppl 5A : Stoll SL. John E. Clinical protocols in obstetrics and gynecology. New Узлы Parthenon Publishing При, F. LingR. H, Ling F. Lescomb G. Roseff, A. LingS. Beard et матки. Diagnosis of pelvic vancosities in women with chronic pelvic pain. Lancet ; Corinne Dix. Acute and chronic pelvic pain. Frederickson, Беременности. Premenstrual syndrome. Current Opinion in Obstet. Howard FM.

    Bevan G. The patient is observed annually in the operated surgeon. sex dating

    The invention relates to medicine, namely to obstetrics and gynecology, and can be узлы for suturing the wounds of the bed of the myomatous node after conservative myomectomy during pregnancy. A known method of suturing a wound on the uterus by suturing two cochlearly wrapped serous-muscular flaps.

    Typically, this method is used for conservative myomectomy after husking a large enough node whose diameter exceeds 10 cm. The technique for suturing a wound on the uterus after enucleation of the node is as follows. Over the greatest convexity of the node, an oval cut is made mainly in the longitudinal direction.

    Фибромаоозные node is captured катки Muso forceps and enucleated in the usual way. Since the uterus is pulled up from the abdominal cavity, bleeding from the bed of the node is small.

    Береманности, a large half of the при is wrapped in a spiral shape inward, similar to the body of a snail, while фиброматозные it to the bed with knotted catgut sutures, thus providing hemostasis. The procedure for suturing is from the edge of the capsule фиброматозные the bottom of the bed. After that, the capsule of the other side is wrapped and hemmed. При the described manner, the wound of the uterus is easily узлы without leaving free spaces and cavities. The systemic tissue connection "into the castle" reliably strengthens the uterine wall.

    Blind A. Atypical gynecological operations. Фидроматозные, when using this method of suturing a wound on the uterus, the following disadvantages are noted:. Беременности main difficulty of the method lies in the fact that it is very difficult to collapse and put a sero-muscular flap in the wound so that, on the one hand, there are no беременности spaces, free cavities and pockets and hemostasis is reliable enough, and on the other hand, that there is no significant compression of the tissues, an excessive number of "snail curls", since each of them significantly violates the location of the tissue layers of the organ.

    There is also a method of suturing a узлы of беремеоности uterus ызлы to катки patent of the Мотки Federation No. The method is as follows. Perpendicular to the edge of the wound, беременности visceral peritoneum and underlying muscle layer are sutured. The thread is transferred to the other мстки.

    Stitch the uterine wall through all layers. The thread is ухлы to the second side and stitched from the edge of узьы wound perpendicular to him muscle layer and visceral peritoneum. The outer tier is located in the middle of the inner tier perpendicular to it. Before tying the suture, the ends of the thread are bred perpendicular to the edges of the wound of матки uterus to беременнгсти side of it. Invert and map the muscle layer. When tying the threads, the muscle layer and the visceral peritoneum are compared.

    The advantages of this method are a careful comparison бернменности the edges of the wound and high hemostaticity, however, the method has the following disadvantages:. There is also фиброматозные a method фиброматозные suturing a wound on the uterus after surgical treatment of the uterus according to the patent of the Russian Federation No. The method consists in passing the thread from the side of the serous membrane of the uterus through the thickness of the wound wall, departing from the edge of the wound, to the bottom of the wound leaving a loop in the wound cavity.

    Next, the thread is carried out from the side of the wound wall closer to its беремпнности and further from the side of the serous membrane from the opposite side of the wound in the region of its edge to the bottom of the wound cavity, leaving a loop in it. Subsequently, the деременности is removed through the thickness of the opposite wall of the wound, departing from its edge. When using this method of suturing a wound on матки uterus, the following disadvantages are матки.

    The objective of the invention is to develop a simple effective method of пир the bed of the myomatous node of any size after conservative myomectomy during pregnancy, which will minimize tissue ischemia due to "rare" suturing, беременпости the prognosis of the formation фиброматозные a postoperative scar and increase the likelihood of a favorable узлы of pregnancy. The technical result of the proposed method is the elimination of the appearance of dead spaces, cavities and pockets, and consequently, hematomas and the implementation of reliable hemostasis by imposing Z-shaped muscle and muscle sutures and thereby reducing blood loss during surgery; obtaining, as a result of suturing wounds on the uterus, a minimal violation of its architectonics, facilitating and accelerating wound healing, and obtaining a more reliable scar allowing to convey pregnancy.

    The problem is solved by the fact that at the 1st stage, the wound is sutured from its corner, a needle with a ligature is inserted at a distance of 1. Then the needle is removed at a distance of 1. Then, departing 2. A clamp is imposed on the ligature tied. Repeat suturing to the opposite corner of the wound with similar sutures. At the 2nd беременности, the ends of the ligatures are injected into матки myometrium directly below its node, and they are punctured on the serous surface of the uterus at a distance of 1.

    Пти 1 shows the technique of applying muscle-muscle Z-shaped sutures when suturing the bed of беременност myomatous node on the uterus 1st stage. Figure при shows the technique of applying muscle-serous sutures when suturing the bed of the myomatous node on the uterus 2nd stage. After appropriate treatment of the skin of the anterior abdominal wall, median laparatomy is performed.

    A pregnant uterus with a myomatous node is taken out into the wound. The myomatous node is enucleated and the wound formed on the uterus formed after enucleation is sutured.

    The incision on the uterus is made over the surface of the node in a circle. After the cut is made, the node is беременности in a blunt and sharp way. After the knot is husked, a curved needle with a piercing diameter is clamped with a Geghar needle holder. Synthetic absorbable suture material - ligature - cm long is inserted into прри needle.

    To suture беременности wound formed after enucleation of the myomatous node with a diameter of cm, при will be required. Suturing the bed of the myomatous node after conservative myomectomy during pregnancy is carried out in 2 stages.

    The first stage of suturing begins with one of the corners of the wound, piercing the needle at a distance of 1.

    A needle with a ligature is carried out under the bottom of the wound and punctured at a distance of 1. Further, with an indentation of 2. The conducted ligature should not fall into the uterine cavity.

    The suture is tightened in a direction parallel to the wound. To facilitate this manipulation, it is advisable to perform manual reduction of the edges of the wound by an assistant. The bed of the husked myomatous node is completely sutured according to the described technique.

    This allows you to achieve information wound edges and almost complete hemostasis. The 2nd stage of suturing is performed at the final closure of the wound. The маьки of the knotted сатки is charged into a pricking needle and injected into the myometrium directly under the node.

    A puncture is made on the serous surface of the uterus at a distance of 1. The ligature is tied in a direction perpendicular to the wound. After controlling hemostasis, abdominal матки is performed. The incision on the anterior abdominal wall is restored in layers. In the absence of signs of узлы bleeding, the drainage is беременности on the second day after surgery. Intraoperatively one-time antibiotics are administered that do not penetrate the placental barrier in order to prevent purulent-inflammatory complications.

    After the operation, dynamic monitoring of the patient and ultrasound monitoring of the fetus are при ебременности. Distinctive features of the proposed method узшы suturing wounds on the uterus in comparison with the prototype are:. Suturing the bed in this way allows you to achieve фиброматозные hemostasis, prevents the occurrence of delaminating hematomas.

    Reducing the total number of sutures leads to minimal trauma, which in узлы leads беременности less uterine ischemia and, consequently, to faster healing of the wound on the uterus and to a more favorable course of the postoperative period.

    This method leads to a more reliable scar formation, capable of prolonging pregnancy. Patient S. Received on November 30, with a diagnosis of menacing premature birth with a gestational age of 28 weeks, фиброматозные fibroids of gigantic proportions.

    Myoma is при during a real pregnancy, беременностии the time of the матки ultrasound study. Gynecological history: menstruation from 14 years old, days after 28 days, mild, painless.

    Pregnancy фибрроматозные the first. A woman is interested in maintaining this pregnancy. Registered in the antenatal clinic, the patient was from яиброматозные weeks of фиброматгзные. A threat of abortion was diagnosed in connection with uterine myoma. At admission, the patient complained of drawing pains in the lower abdomen. Received preservation therapy: magnesia маткки. When conducting an ultrasound study in the беременносьи, secondary changes were identified. In this regard, on Матки 2, under endotracheal anesthesia, a lower-median laparotomy was performed.

    The myomatous node was husked. In this case, the uterine cavity was not opened. On the bed of the myomatous node, 9 sutures were applied according to the claimed method. Additional peritonization was not performed.

    Produced toilet abdominal cavity. The wound on the anterior abdominal wall is фиброматознфе in layers tightly. Total при loss was ml. In the postoperative period, preservation therapy with magnesia беременноости dynamic observation of the фиброамтозные by ultrasound беременнности were performed.

    Rises матки body temperature have not been reported. Sutures were removed on the 11th day of the postoperative period. Discharged from the hospital on the 18th day of the postoperative period in при satisfactory condition with узлы progressing pregnancy. Recommendations on prenatal hospitalization for planned abdominal delivery by cesarean section are given.

    At 36 weeks, regular labor began and it was decided to perform a cesarean section according to the totality of indications: Age-old primiparous 37 years, uterine scar after conservative myomectomy during pregnancy at 28 weeks of gestation. On January 3,at 0 hours and 50 minutes, a cesarean section was performed in the lower segment of узлы uterus. A live premature boy weighing g and a length of маткки cm was removed from the head.

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    The invention relates to medicine, namely, gynecology, and can be used for closure of wounds on the uterus after conservative myomectomy, after reconstructive-plastic surgery, manufactured for uterine malformations, after iatrogenic uterine wounds such as uterine perforation during abortion or dilatation and curettage its cavity after surgery corporal caesarean section, with cervical stump suturing supravaginal after hysterectomy.

    Thus, the invention can be used in virtually any operations on the uterus, excluding caesarean section in the lower uterine segment. Known is a method of фиброматозные a wound in the uterus by sewing two ulitkoobrazno wrapped sero-muscular grafts.

    Typically, this method is used for conservative myomectomy after husking sufficiently large node whose diameter exceeds 10 cm. Technique suturing wounds on the uterus after enucleation node is as follows.

    Above the highest convexity node advantageously made oval section беременности the longitudinal direction. Node grip forceps Museo enucleated and conventional manner. Since the uterus from the peritoneal cavity tightened up, the bleeding of a small bed assembly. Then the larger half capsule is wrapped in a spiral inside the snail-like body, simultaneously hemming it to lodge knotted catgut sutures, thereby providing hemostasis.

    The procedure for sutures - from the edge of the узлы to the bottom of the bed. After this wrapped and sutured capsule on the other hand. Described method of фиброматозные wound sutured easily without leaving free gaps and cavities. System connection беременности "in lock" reliably strengthens the uterine wall. However, with this method of wound closure on the uterus is noted the formation of a very rough scar, changing shape of the uterus due to the fact that there is a pronounced violation of the histological structure of authority, failure to comply with the tissue layers.

    But be aware that матки buduyuschey pregnancy spot formed by the surgeon of the scar при become part of the placenta при points, so the normal structure of the uterine wall at the site фиброматозные necessary as prevention of disorders беременности the utero-placental blood flow and such severe complications sequence period as a dense attachment of the placenta, requiring the operation of the manual removal of the placenta, and complete placenta accreta, which requires hysterectomy.

    Otherwise, it is technically impossible ulitkoobraznoe folding edges of the wound. The main difficulty in the method is that it is very difficult to collapse and pack the wound sero-muscular flap so that, on the one hand, no dead spaces, free of cavities and pockets, and hemostasis was reliable enough and, on the other hand, to there was no significant compression of tissues, excessive amounts of "curls snail", as each of them was significantly disturbed by the location of the tissue layers of the body.

    According closest the technical essence as a prototype we have chosen a при of suturing a wound in the uterus, is as follows. Starting from the bottom of the wound, the individual repeatedly applied from catgut sutures, better vosmiobraznye.

    Thus it is necessary to seek reliable hemostasis and eliminate the dead spaces that allow the formation of haematomas. Only at the end of the overlay multi-row muscle-joint muscle can cut off the excess fabric formed, for example, узлы to distension of the uterus fibromatous node. Then placing sero-muscular continuous looped seam of catgut. Persianinov LS Operative gynecology M. In this regard, spontaneous vaginal delivery path becomes very problematic, and, as a rule, preference is given to operative delivery by cesarean section.

    Thus, the object of the invention to reduce the operation time on the uterus, its complexity and difficulties of blood loss during the operation and shortening узлы the postoperative stay in hospital, forming a gentle non-deformable scar on the uterus and фиброматозные a minimum number of adhesions in the pelvic area, and as a consequence the entirethe preservation or even the restoration of reproductive function and ensuring the normal course of pregnancy, birth vaginally and the postpartum period.

    The problem беременности solved by the fact that the wound suture фиброматозные the uterus made our suggested way. This seam involves performing thread from the serous membrane of the uterus through the thickness wounds wall some distance from the wound edge to the bottom of the wound, leaving a wound site loop. Later the thread fed through the thickness of the wound opposite wall, some distance from its edges.

    It should фиброматозные noted that the omega-shaped sewn seams both беременности wound times, and then tighten all the seams simultaneously, so that the wound edges turned immersed in the wound cavity. Let us consider the implementation of the method of suturing the wound in the uterus for example conservative myomectomy operation, since the operation is an example of the most commonly performed reconstructive-plastic surgery on the uterus. After the anterior abdominal wall of the corresponding treatment of the skin is made by Pfannenstiel incision.

    The uterus is output to the wound. Consistently enucleated fibromatous components and sutured formed after enucleation wounds on the uterus, following the principle that the узлы are removed in order of their size, that is first determined by palpation and remove the maximum size of the node, then the second матки, and so on.

    For each node selected according to its size the needle, suture, thread length, the distance between the puncture.

    The матки above the uterine produce assembly surface, and strictly for assembly prior to its center of the capsule. It при important to immediately "get into the bed," that is to make the incision immediately reached the capsule, otherwise, if we get to the muscle layer, it is узлы there will bleed heavily.

    After the incision беременности made and appeared bright and shiny capsule node, the node Museo grip forceps матки pulling it up gradually husks it with the blunt scissors, curved in the plane Cooper. After vyluschen node, take the needle holder and clamp them Gegara curved needle with a triangular cutting diameter. The size of the needle is selected individually in each case depending on the size of the wound, and most importantly, on its depth.

    Catgut then taken from N to 4 and N 6 vdevayut при the needle. The thread is cut so that its length was cm. The wound closure formed after enucleation fibromatous assembly diameter of cm, фиброматозные need to impose omega-shaped seam. Therefore mentally divide each formed sero-muscular lockutov in their bases into 4 parts. Origin vkoly make the base of one of the flaps on the boundary between the фиброматозные and second quarter. Needle with a thread carried in wall thickness wound so that the needle came out in the bottom of the wound closer to the side corresponding to the first flap is sewn.

    Next, puncture is carried on при inner side of the same flap, some distance of 0. As a result, the thread is already in the outer surface of the same sero-muscular flap. Next, puncture is carried on the outer side of the second sero-muscular flap some distance from its top as 0.

    As a result, the thread turns on the inside surface of the second flap. Leaving a small wound site free loop carried puncture wound in узлы bottom on the same side with which узлы a base of the second flap.

    Next the needle is carried out in the wall thickness wound so as to materialize vykoli just at the base of the second sero-muscular flap. Not tightening the thread proceeds to omego- second stitch. To do this, take a new thread catgut N 5, the length of cm and vdevayut it in the same needle, which is in the same needle holder. Origin vkoly carried out in the same base flap, which is pierced when the first application of the first omega-shaped seam at the boundary between the second and third quarter.

    Similarly, a third omega-shaped seam is performed. Now go to the tightening of all three omega-shaped joints. Previously, no need to do that, as you need to constantly see the entire bottom of the wound to the right was the advancement of the needle, since the imposition of each omega-shaped seam is performed first pitch dark in the wound беременности, and then puncture the bottom матки the wound.

    Tightening of the three omega-shaped stitches may be carried out simultaneously with the assistant if he has при tactile sensitivity and if the surgeon fully trust him. Tightening of omega-shaped seams very important time of the transaction. It is better if all при omega-shaped seam tightened simultaneously assistant helps the surgeon. If the surgeon has decided to prolong itself all omega-shaped seam 3, then it must first tighten and fasten one of the outer seams, then the seam which is located in the middle, and finally the third joint disposed at the other end.

    Tying all the joints carried a surgical knot. Once all nodes fibromatous enucleated and all the wounds on the uterus sutured omega-shaped seams, proceed to the toilet of the abdominal матки. For more peritonization not produce. Further sutured peritoneum continuous catgut suture. In the same continuous catgut suture sutured muscle. Then continuous catgut suture sewn aponeurosis. Subcutaneous fat did not sew.

    The skin is pierced by three sutures узлы Danat. Blood loss during operation when fibromatous many nodes 13 - 20 is approximately ml. Postoperatively, the blood is not transfused. Infusion therapy is carried out during the при day in a volume of 1. Antibacterial therapy performed: ampicillin 1 g 4 times a day, gentamycin 0. During the first five days of injected reducing agents: oxytocin 10 units 1 mL two times a day.

    Sutures with матки of the anterior abdominal wall are removed on the fifth day. On the fifth day begin physical therapy: microwave, UHF, ultrasound. Statement made on day. Flashing both walls of the uterus wound omega-shaped seams causes that the seams are soft, there is no compression of the tissue. It is important to note that the application of omega-shaped seam leads to the fact that there is a direct contact of the muscle membranes both walls of the wound, almost no injured or needle or catgut strings.

    As a result, free, direct comparison of the two muscle layers are formed sufficiently durable, but at the same time and gentle, practically imperceptible scar minimally violating the architecture of the uterine wall because the vessels, nerves and muscle fibers of the muscular layer of a wound walls readily germinate muscular беременности opposite wall wounds.

    All of this is the prevention of further utero-placental insufficiency, complications during childbirth and the postpartum period. Reducing the total фиброматозные of stitches to results in minimal traumatization to the tissue and minimal introduction into the body catgut filaments, which in turn leads to rapid healing of wounds on the uterus and a smoother flow of the postoperative period.

    The absence of blue-serous sutures also contributes to a gentle, almost invisible scar and reduce the number of adhesions in the pelvic area, resulting from the operation, which in turn increases the likelihood of pregnancy within the next years.

    Dive sero-muscular edges of the wound at the wound site allows adequate hemostasis and to avoid the formation of dead spaces, cavities and pockets, leading to the formation of hematomas, узлы are prone to subsequent fester.

    Example N 1. Patient K. He admitted to the hospital N 15, March 25, in the direction of the women's clinic with a diagnosis of threatened abortion at 22 weeks' gestation, uterine fibroids. Fibroids diagnosed during the current pregnancy, at the time of inspection the woman when registering for pregnancy. Prior to this patient for five years did not apply to the gynecologist. Gynecological history: menstruation from the age of 14, days, after 28 days, not abundant, painless. Pregnancy - one in at age 27over a medical abortion.

    Abortion complications were noted. Sincehe did not live to sexual life. In he entered a second marriage, which in the same матки the pregnancy. The preservation of the pregnant woman is interested. Registered матки the antenatal clinic patient was 12 weeks pregnant. It was immediately diagnosed with the threat of termination of pregnancy due to uterine fibroid. January 14,was hospitalized in the hospital antenatal department N 15 in connection with the threat of termination of pregnancy.

    On admission the patient complained беременности dragging pain in the abdomen.

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