Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации6564UnclassifiedDIFFERENTIAL DIAGNOSIS BETWEEN PARTIAL BUBBLE TRANSFER AND ENDOMETRITIS CAUSED BY HERPES SIMPLE VIRUS (CLINICAL CASE)ZolotukhinVladimirvladimir.zolotuxin@gmail.comhttps://orcid.org/0000-0002-8513-3966ArzhanykhYanayana.arzhanyh@yandex.ruhttps://orcid.org/0000-0001-9064-06231405202110S120232802202101032021Copyright © 2021, Молодежный инновационный вестник2021<p>RELEVANCE.The demographic situation in the Russian Federation is such that every desired pregnancy, if possible, should end with the birth of a child (1).</p>
<p>OBJECTIVE demonstrate difficult for the practitioner clinical case,claimingthe firstnon-trivial solution-Differentialfirstdiagnosed between the partial molar pregnancy, and viral endometritis.</p>
<p>MATERIALS AND METHODS: A case of uterine pregnancy developing against the background of endometritis caused by the herpes simplex virus type 1 and aggravated by the threat of miscarriage</p>
<p>RESULTS OF THE STUDY:Bubble drift is one of the most dangerous obstetric complications, in which it is necessary to take urgent and drastic measures to terminate pregnancy with further treatment by agynecological oncologist.The disease is characterized by severe nausea, vomiting, bleeding from the genital tract.On examination, a discrepancy between the size of the uterus and the gestational age is revealed.</p>
<p>RESULTS:Aiagnoz "partial molar pregnancy Pregnancy 6-7 weeks" had to be set at this stage, and the subsequent medical tactic was to Ackits approved or refutation of this disease.</p>
<p>DISCUSSION:Among the diseases that can causethese complaints withcomplaints of scanty bleeding from the genital tract, delayed menstruation, nausea, vomiting in the morning are rare, viral infections, in particular endometritis caused by HSV, have been identified.</p>
<p>CONCLUSION: Full or partial cystic drift is a life-threatening condition for a woman, as it refers to precancerous diseases.Therefore, in the case of the slightest suspicion of a PP, it is necessary, based on the principle ofoncological vigilance, first of all, to exclude it</p>pregnancy, hydatidiform mole , herpes simplex virus , diagnosisбеременность, пузырный занос, вирус простого грпеса, диагностика<p>RELEVANCE.The demographic situation in the Russian Federation is such that every desired pregnancy, if possible, should end with the birth of a child.In this regard, the correct obstetric tactics is extremely important, whichmust be formedstarting from the first weeks of pregnancy.This is especially true of clinical cases that are difficult to diagnose, for which an approach based on modern clinical guidelines of the Ministry of Health of the Russian Federation is especially needed.</p>
<p>OBJECTIVE demonstratedifficult for the practitioner clinical case,claimingthe firstnon-trivialsolutions-Differentialfirstdiagnosed between the partial molar pregnancy, and viral endometritis.</p>
<p>MATERIALSAND METHODS.A case of uterine pregnancy developing against the background of endometritis causedby the herpessimplex virus type 1 and aggravated by the threat ofmiscarriage.In this regard, the clinical picture partly resembled a hydatidiform mole, which required a complex differential diagnosis.<span class="">The following methods were used in the work: general clinical examination, bacterioscopic method,</span><span class="">enzyme immunoassay</span><span class="">method, nucleic acid amplification method, ultrasound</span><span class="">examination</span><span class="">.</span></p>
<p>RESULTS OF THE STUDY: For consultation in acuwersky Remote Advisory Center (ADKTS)BUZ IN GKBSMP№10 wasdirected patient 24 years with complaints about the meager amount of bleeding from the genital tract, delay menstruation, nausea, vomiting in the mornings is rare.</p>
<p>Anamnesis data.Somatic and obstetric-gynecological anamnesis are not burdened, the real pregnancy is the first, came within 2-3 months.The last menstrual period -7weeks ago, proceeded as usual.Initially, the woman consulted a doctor at a paid clinic.On examination, a uterus was found, enlarged,respectively, 6-7 weeks ofpregnancy, the cervicalcanal is closed, from the canal - scanty bleeding.Ultrasound revealed uterine pregnancyfor a period of 6 weeks and 5 days (CTE of theembryo - 75 mm), the heartbeat of theembryo -170 beats per minute, chorion along the anterior wall of the uterus, in the chorion area, severalhypoechoicinclusions with a diameter of 1-2 mm were found.The laboratory examination data corresponded to the pregnancy rate, -hCG was29790mIU/ ml, whichcorresponded to the period of6-7 weeks of pregnancy.</p>
<p>After 3 days, the patient was examined by the staff of the ADKTS BUZ VO GKBSMP # 10.Vaginalexaminationdatacorresponded to the clinical picture of a 7-week uterine pregnancy, the threat of miscarriage.Repeated ultrasoundon an expert class apparatus revealed that pregnancy was developing(CTE of the embryo was 91 mm), the heart rate wasdetermined at 165 beats per minute, the corpus luteum of pregnancy was detected on the left.The above described<a name="_Hlk64204073"></a>hypoechoic<a name="_Hlk64204073"></a>inclusions in the chorionic region were<a name="_Hlk64204073"></a>also visualized.<a name="_Hlk64204073"></a></p>
<p>Employees of theAdvisoryCenter and theDepartment of Obstetrics and Gynecology No. 2 VSMU named afterN.N.Burdenkoheld a consultation, which was faced with the task ofmaking adiagnosis and determining further tactics of pregnancy management.</p>
<p>To make a diagnosis, it was necessary to carry out a differential analysisbetween cysticdrift, as the most dangerous complication of pregnancy, having the above symptoms and other conditions withsimilar signs.</p>
<p>Bubble driftis one of the most dangerous obstetric complications, inwhich it is necessaryto take urgent and radical measures to terminate pregnancy with further treatment by agynecological oncologist.The disease is characterized by severe nausea, vomiting, bleeding from the genital tract.On examination revealed carryingootvetstvie between uterine size and gestational age.Ultrasound visualizes a picture of a "snow storm" - multiple smallhypoechoicstructures against the background of reflections of increased intensity.Pathognomonic is a significant increase in-HCG incomparison with the pregnancy rate.Within a short time after the formation of the PZ, the fetus dies and the pregnancy freezes.</p>
<p>RESULTS:It should be noted that the described clinical picture is typical for complete cystic drift, with partial, some symptoms, in particular ultrasound signs and the growth of B-hCG, are not so unambiguous.In addition, thedisease could have been detected at the very beginning and the death of the embryo might not have occurred yet.</p>
<p>Therefore, the diagnosis "Partial cystic drift during pregnancy 6-7 weeks" had to be exposed at this stage, and the subsequent medical tactics were reduced to confirming or refuting this, the most terrible obstetric condition.I would also like to emphasize that at this stage there was not enough data forabrasiocaviuteri.</p>
<p>DISCUSSION:Among the diseases that can cause the above-described symptoms,viralinfections, in particular endometritis caused by HSV, have beenidentified.After additional history taking, Idreamed that the patient was suffering fromrecurrentHerpeslabialis.I was exposed tothe diagnosis of "Pregnancy7weeks1 daythreatening abortion (O.20), partialmolar pregnancy (O.01), herpes gestationis (O.26.5)."It was decided to prolong the pregnancy and assign conserving therapy progestins (Duphaston20 mg), following a visit to AKDTS - 2weeksafter there-thdeterminationIB-HCG andBfollow on HSV.At the next consultation, the pregnant woman continued to complain of nausea, vomiting in the morning, bleeding from the genital tract stopped.At vaginal examination, the size of the uterus corresponded to 9-10 weeks of pregnancy, the cervical canal is closed, the discharge from it is mucous, in the area of the appendages - no features.Ultrasound revealed a progressive uterine pregnancy for a period of 9 weeks (fetal CTE-5 cm), heartbeat - 160 beats per minute),hypoechoicinclusions in the chorionic regionwere preserved.B-hCG corresponded to24983 mIU / ml, which issomewhatless than the gestational age.Testing for herpes simplex virus revealed a high level of antibodies to herpes simplex viruses type 1 (JgG-10.62 with the upper limit of the norm up to 0.59).At the same time, the DNA of the pathogen was not detected in cervical and vaginal secretions.At this stage, the diagnosis was made:Pregnancy9weeks2 days, herpes of pregnant women (O.26.5).Considering the high level ofJgGin thepresence of a clinic of threatened abortion, the woman was advised to visit an infectious disease specialist to decide on the appointment of specific antiviral therapy.Also, recommendations were given for furtherexamination andmanagement of pregnancy in accordance with the clinical protocol "Normal pregnancy" 2020.The pregnant woman was reported to the antenatal clinic at the place of residence.</p>
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<p>CONCLUSION.Full or partial cystic drift is a life-threatening condition for a woman, as it refers to precancerous diseases.Therefore, in the case of the slightest suspicion ofPZ,it is necessary, based on the principle ofoncological vigilance, first of all, to exclude it.Iftrophoblasticdisease is excluded, further obstetric tactics should be built, ifpossible, in thedirection of maintaining pregnancy.A viral infection, of course, is a serious obstetric complication, but at the same time it does not pose a threat to a woman's life andmay result in the birth of aviable fetus.However, the joint management of pregnancy complicated by aninfectioncausedby the herpes simplex virusshould be carried out jointly with an infectious disease doctor.</p>