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OBSTETRIC PATOLOGIC
1 MINISTERUL OCROTIRII S+N+T+|II AL REPUBLICII MOLDOVA

UNIVERSITATEA DE STAT DE MEDICIN+ {I FARMACIE
NICOLAE TESTEMI|ANU
Gheorghe PALADI
Olga CERNECHI
Obstetric= patologic=
Manual
Vol. II
Chi[in=u
Centrul Editorial-Poligrafic Medicina
2008
2
GH. PALADI, OLGA CERNECHI
CZU 618.1(075.8)
P14
Aprobat de Consiliul Metodic Central al USMF Nicolae Testemianu
proces-verbal nr. 7 din 2 februarie 2006
Autori: Gheorghe PALADI academician ARM, d.h..m.,
profesor universitar
Olga CerneChi d.h..m., profesor universitar,
ef catedr Obstetric i Ginecologie
(Rezideniat)

Colectivul de autori: Taisia Eanu d..m., confereniar universitar
Zinaida Srbu d..m., confereniar universitar
Ia. Metaxa d..m., confereniar universitar
Uliana Tabuic d..m., asistent universitar
S. Hodorogea d..m., asistent universitar
Larisa Catrinici asistent universitar
Ludmila Stavinskaia asistent universitar
Corina Iliadi-Tulbure medic doctorand
V. Moin d.h..m., profesor universitar
E. Guu d.h..m., confereniar universitar
D. Casian d..m., confereniar universitar
N. Cuco d..m., confereniar universitar

Asisten computerizat: Diana Savva
Redactor: Valentina Batr
Coperta: Veaceslav Popovschi
Machetare computerizat: Elena Curmei
Corectori: Nadejda Koporskaia, Tatiana Colin
CEP Medicina, 2008
ISBN 978-9975-915-32-8 Gh. Paladi, O. Cernechi, 2008
MINISTRY OF HEALTH AND SOCIAL PROTECTION OF REPUBLIC OF MOLDOVA
STATE UNIVERSITY OF MEDICINE AND PHARMACY
NICOLAE TESTEMI|ANU
Gheorghe PALADI
Olga CERNECHI
Pathological obstetrics
Manual
Vol. II
Chi[in=u
Editorial Centre-Poligrafic Medicine
2008
Descrierea CIP a Camerei Naionale a Crii
Paladi, Gheorghe
Obstetric patologic : Man. / Gheorghe Paladi, Olga Cernechi; Univ. de Stat
de Medicin i Farmacie Nicolae Testemianu. Ch.: CEP Medicina, 2008.
ISBN 9789975915311
Vol. 2. 2007. 744 p. ISBN 9789975915328 : 100 ex.
CZU 618.1(075.8)
ntreprinderea de Stat, Firma Editorial-Poligrafic Tipografia Central,
MD-2068, Chiinu, str. Florilor, 1. Tel.: 43-03-60, 49-31-46
OBSTETRIC PATOLOGIC
3 MINISTRY OF HEALTH AND SOCIAL PROTECTION OF REPUBLIC OF MOLDOVA
STATE UNIVERSITY OF MEDICINE AND PHARMACY
NICOLAE TESTEMI|ANU
Gheorghe PALADI
Olga CERNECHI
Pathological obstetrics
Manual
Vol. II
Chi[in=u
Editorial Centre-Poligrafic Medicine
2008
4
It was approved by Methodic Central Council of USMF Nicolae Testemianu,
verbal-report nr. 7 from 2 february 2006
Editors: Gheorghe PALADI academician of SA RM,
universitary professor
Olga CerneChi universitary professor,
chairman department of Obstetrics
and Gynecology (for rezidents)

Part editors: Taisia Eanu universitary lecturer
Zinaida Srbu universitary lecturer
Ia. Metaxa universitary lecturer
Uliana Tabuica universitary assistant
S. Hodorogea universitary assistant
Larisa Catrinici universitary assistant
Ludmila Stavinskaia universitary assistant
Corina Iliadi-Tulbure candidate for doctors degree
V. Moin universitary professor
E. Guu universitary lecturer
D. Casian universitary lecturer
N. Cuco universitary lecturer
Computer assistance: Diana Savva
Editor: Valentina Batr
Cover: Veaceslav Popovschi
Computer upmaking: Elena Curmei
Corectors: Nadejda Koporskaia, Tatiana Colin
CEP Medicina, 2008
ISBN 978-9975-915-32-8 Gh. Paladi, O. Cernechi, 2008
OBSTETRIC PATOLOGIC
5
Aprobat de Consiliul Metodic Central al USMF Nicolae Testemianu
proces-verbal nr. 7 din 2 februarie 2006
LISTA AUTORILOR
Gheorghe Paladi
Academician al A a Republicii Moldova
Doctor habilitat n tiine medicale
Profesor universitar
Catedra Obstetric i Ginecologie (Rezideniat)
Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu,
Chiinu
Olga Cernechi
Prorector pentru asigurarea calitii i integrrii n nvmnt
ef catedr Obstetric i Ginecologie (Rezideniat)
Chiinu
recenzeni:
Marin Rotaru
Chiinu
Catedra Obstetric i Ginecologie a Facultii de Medicin General
Traian Rebedea
Catedra Obstetric i Ginecologie (Romnia)

6
It was approved by Methodic Central Council of USMF Nicolae Testemianu,
verbal-report nr. 7 from 2 february 2006
EDITORS
Gheorghe Paladi
Academician of SA Republic of Moldova
Universitary professor
Department of Obstetrics and Gynecology (for rezidents)
State University of Medicine and Pharmacy Nicolae Testemianu,
Chiinu
Olga Cernechi
Chairman department of Obstetrics and Gynecology (for rezidents)
Chiinu
Reviewers:
Marin Rotaru
Department of Obstetrics and Gynecology
Chiinu
Traian Rebedea
Department of Obstetrics and Gynecology (Romnia)

OBSTETRIC PATOLOGIC
7
AU COLABORAT
Taisia eanu
Doctor n tiine medicale
Confereniar universitar
Chiinu
Consultant SCM nr.1
Zinaida Srbu
Chiinu
Consultant SCM nr.1
Ia. Metaxa
Chiinu
Uliana Tabuic
Asistent universitar
Chiinu
S. hodorogea
Catedra Obstetric i Ginecologie
Chiinu
8
Larisa Catrinici
Catedra Obstetric i Ginecologie
Chiinu
Ludmila Stavinskaia
Chiinu
Corina Iliadi-Tulbure
Medic doctorand
Chiinu
V. Moin
Directorul Centrului Naional de Sntate Reproductiv i Genetic Medical
e. Guu
Catedra Chirurgie General i Semiologie
Chiinu
D. Casian
Catedra Chirurgie General i Semiologie
Chiinu
n. Cuco
Catedra Medicin de Familie
Chiinu
OBSTETRIC PATOLOGIC
9
CONTRIBUTORS
Taisia eanu
Universitary lecturer
Chiinu
Zinaida Srbu
Chiinu
Ia. Metaxa
Chiinu
Uliana Tabuica
Universitary assistant
Chiinu
S. hodorogea
Chiinu
Larisa Catrinici
Chiinu
10
Ludmila Stavinskaia
Chiinu
Corina Iliadi-Tulbure
Candidate for doctors degree
Chiinu
V. Moin
Director of National Health Reproductive and Medical Genetics Center
e. Guu
Department of Surgery
Chiinu
D. Casian
Department of Surgery
Chiinu
n. Cuco
Department of Family Medicine
Chiinu
OBSTETRIC PATOLOGIC
11
CUPRINS
Prefa\= ........................................................................................................................ 19
CAPITOLUL I
Patologia extragenital= asociat= sarcinii .................................................................. 23
Generalit=\i .............................................................................................................. 23
Bolile aparatului cardiovascular. Gh. Paladi, N. Cuco[ .......................... 24
Patologia sistemului respirator. U.Tabuica .................................................. 39
Patologia hepatic=. O. Cerne\chi .................................................................... 49
Bolile tractului urinar. O. Cerne\chi .............................................................. 54
Endocrinopatiile. Gh. Paladi ............................................................................ 62
Obezitatea. Gh. Paladi ...................................................................................... 76
Sindromul antifosfolipidic. Gh. Paladi .......................................................... 78
Patologia ocular=. O. Cerne\chi, U. Tabuica ............................................... 87
Tulbur=rile hematologice ]n sarcin=. Gh. Paladi ........................................ 91
CAPITOLUL II
Gestoza precoce. Nauseea [i voma gravidelor.
Gh. Paladi, U. Tabuica ........................................................................................ 116
CAPITOLUL III
St=rile hipertensive ]n sarcin=. Gh. Paladi, S. Hodorogea ..................... 121
CAPITOLUL IV
Izoimunizarea dup= Rh-factor. O. Cerne\chi ............................................. 155
CAPITOLUL V
Prematuritatea. O. Cerne\chi ......................................................................... 177
CAPITOLUL VI
Patologia anexelor fetale. Gh. Paladi, U. Tabuica .................................... 190
CAPITOLUL VII
Boala trofoblastic= gesta\ional= (BTG). U. Tabuica, C. Iliadi
-
Tulbure .. 223
CAPITOLUL VIII
Sarcina extrauterin=. O. Cerne\chi ............................................................. 247
CAPITOLUL IX
Supramaturitatea. Gh. Paladi ........................................................................ 267
CAPITOLUL X
Retardul de dezvoltare intrauterin= al f=tului.
Gh. Paladi, C. Iliadi
-
Tulbure ............................................................................. 273
CAPITOLUL XI
Infec\ia materno-fetal= [i sarcina. O. Cerne\chi, T. E[anu .................... 294
CAPITOLUL XII
Sarcina oprit= ]n evolu\ie. Moartea antenatal= a f=tului.
Gh. Paladi, U. Tabuica .......................................................................................... 323
CAPITOLUL XIII
Patologia chirurgical= ]n sarcin= ............................................................................ 334
12
Abdomen acut chirurgical ]n timpul sarcinii. E. Gu\u ............................. 334
Tromboza ]n sistemul venei cave inferioare
]n timpul sarcinii [i perioadei post-partum E. Gu\u, D. Casian ........... 351
CAPITOLUL XIV
Tumorile benigne [i maligne ale organelor genitale [i sarcina.
Gh. Paladi ............................................................................................................... 365
CAPITOLUL XV
Hemoragiile obstetricale. Gh. Paladi, S. Hodorogea ............................... 382
CAPITOLUL XVI
Na[terea indus=. Gh. Paladi .......................................................................... 432
CAPITOLUL XVII
Patologia activit=\ii contractile a uterului. Gh. Paladi, Ia. Metaxa ..... 439
CAPITOLUL XVIII
Distociile canalului osos. Gh. Paladi, T. E[anu .......................................... 476
CAPITOLUL XIX
Macrosomia fetal=. Dispropor\ia feto-pelvin=. U. Tabuica .................... 494
CAPITOLUL XX
Prezenta\iile pelviane a f=tului. Gh. Paladi, T. E[anu .......................... 501
CAPITOLUL XXI
Anomaliile de prezenta\ie [i pozi\ie a f=tului. T. E[anu ......................... 533
CAPITOLUL XXII
Opera\ii obstetricale, folosite pentru terminarea rapid= a na[terilor.
O. Cerne\chi, T. E[anu ........................................................................................ 546
CAPITOLUL XXIII
Opera\ia cezarian=. Gh. Paladi ..................................................................... 565
CAPITOLUL XXIV
Traumatismul obstetrical. Gh. Paladi, L. Catrinici ................................... 582
CAPITOLUL XXV
Infec\ia puerperal-septic=. V. Luca ............................................................. 604
CAPITOLUL XXVI
St=rile critice ]n obstetric=. Gh. Paladi, U. Tabuica ................................ 657
CAPITOLUL XXVII
Resuscitarea nou-n=scutului. Z. S`rbu ....................................................... 688
CAPITOLUL XXVIII
Reproducerea asistat=. V. Mo[in .................................................................. 707
CAPITOLUL XXIX
Aspecte psihologice ale obstetricii contemporane.
Gh. Paladi, L. Stavinskaia .................................................................................. 718
Indice ............................................................................................................................. 731
OBSTETRIC PATOLOGIC
13
TABLE OF CONTENTS
Preface ........................................................................................................................ 19
CHAPTER I
Extrauterine pathology associated in pregnancy ................................................. 23
Generalities ............................................................................................................... 23
Pathology of cardiovascular system. Gh. Paladi, N. Cuco[ ....................... 24
Pathology of respiratory system. U. Tabuica ............................................... 39
Liver pathology. O. Cerne\chi ......................................................................... 49
Urinary tract disease. O. Cerne\chi ................................................................ 54
Endocrinophaties. Gh. Paladi ........................................................................... 62
Obesity. Gh. Paladi ............................................................................................. 76
Antiphosfolipid syndrome. Gh. Paladi ........................................................... 78
Ocular pathology. O. Cerne\chi, U. Tabuica ................................................ 87
Hematologic pathology. Gh. Paladi ................................................................ 91
CHAPTER II
Nausea and vomiting during pregnancy. Gh. Paladi, U. Tabuica ........ 116
CHAPTER III
Hypertensive disorders in pregnancy. Gh. Paladi, S. Hodorogea ......... 121
CHAPTER IV
Rh isoimmunization. O. Cerne\chi ................................................................ 155
CHAPTER V
Prematurity. O. Cerne\chi ............................................................................... 177
CHAPTER VI
Pathology of fetal annexes. Gh. Paladi, U. Tabuica ................................. 190
CHAPTER VII
Gestational trophoblastic diseases. U. Tabuica, C. Iliadi-Tulbure ....... 223
CHAPTER VIII
Extrauterine pregnancy. O. Cerne\chi .......................................................... 247
CHAPTER IX
Postterm pregnancy. Gh. Paladi .................................................................... 267
CHAPTER X
Intrauterine growth restriction. Gh. Paladi, C. Iliadi-Tulbure ............... 273
CHAPTER XI
Maternal and fetal infection in pregnancy. O. Cerne\chi, T. E[anu .. 294
CHAPTER XII
Intrauterine fetal death. Gh. Paladi, U. Tabuica ......................................... 323
CHAPTER XIII
Surgical pathology in pregnancy .............................................................................. 334
Acute abdomen during pregnancy. E. Gu\u ............................................... 334
Vein thrombosis in cava system in pregnancy and post-partum.
E. Gu\u, D. Casian .................................................................................................. 351
14
CHAPTER XIV
Benign and malign genital tumours and pregnancy. Gh. Paladi .......... 365
CHAPTER XV
Obstetrical haemorrage. Gh. Paladi, S. Hodorogea .................................. 382
CHAPTER XVI
Induced labor. Gh. Paladi ............................................................................... 432
CHAPTER XVII
Uterine contractility activity pathology. Gh. Paladi, Ia. Metaxa ......... 439
CHAPTER XVIII
Anatomical narrow pelvis. Gh. Paladi, T. E[anu ....................................... 476
CHAPTER XIX
Fetal macrosomia. Feto-pelvian disproportion. U. Tabuica .................... 494
CHAPTER XX
Breech presentation. Gh. Paladi, T. E[anu ................................................ 501
CHAPTER XXI
Fetal presentation and position anomalies. T. E[anu .............................. 533
CHAPTER XXII
Obstetrical operations. O. Cerne\chi, T. E[anu ........................................ 546
CHAPTER XXIII
Caesarean section. Gh. Paladi ........................................................................ 565
CHAPTER XXIV
Obstetrical traumatism. Gh. Paladi, L. Catrinici ........................................ 582
CHAPTER XXV
Puerperal-septical infection. V. Luca ........................................................... 604
CHAPTER XXVI
Critical states in obstetrics. Gh. Paladi, U. Tabuica ................................. 657
CHAPTER XXVII
Newborn resuscitation. Z. S`rbu ................................................................... 688
CHAPTER XXVIII
Assisted reproduction. V. Mo[in ................................................................... 707
CHAPTER XXIX
Psychological aspects of contemporary obstetrics.
Gh. Paladi, L. Stavinskaia .................................................................................. 718
Index ................................................................................................................................. 731
OBSTETRIC PATOLOGIC
15
ABREVIERI
A variaia frecvenei medii
AA apendicit acut
AB astm bronic
Ac anticorpi
ACTD actinomicina-D
ACTH hormonul adrenocorticotrop
ADF adenozindifosfat
ADH hormonul antidiuretic
ADN acid dezoxiribonucleic
AF anemie ferodefcitar
AFL antifosfolipidic
AFS antifosfolipidic sindrom
Ag antigen
ALL leucemie acut limfocitar
ALT alanin-aminotransferaz
AML leucemie acut mieloblastic
AOC anamnez obstetrical complicat
AP abruptio placentae
ARN acid ribonucleic
ASCCM American Society of Critical Care Medicine
AST aspartat-aminotransferaz
ATF adenozintrifosfat
AT-III antitrombin-III
ATP aport insufcient de energie
ATS antitiroidiene de sintez
BA bronit acut
BC bronit cronic
BCF btile cordului fetal
BIP boal infamatorie pelvin
BL bilirubin
BPCO bronhopneumonie cronic obstructiv
BTG boala trofoblastic gestaional
BTP boala trofoblastic persistent
C grade Celsius
CA 1. circumferin abdominal; 2. colecistit acut
Ca++ calciu
CC 1. cardiopatii congenitale; 2. circumferina cranian; 3. coriocarcinom
CCU cancerul colului uterin
CGM cancerul glandei mamare
Ch tratament chirurgical
CID-sindrom sindromul de coagulare intravascular diseminat
Cl clor
CM cardiomiopatii
cm centimetru
CMV citomegalovirus
CO 1. cancerul ovarian; 2. cordonul ombilical
COC contraceptive orale combinate
CT Chlamydia trachomatis
CTG cardiotocografe
D variaia frecvenei telediastolice
DBP diametru biparietal
DP depresie postnatal
DZG diabetul zaharat gestaional
ECG electrocardiografe
16
EDRF factorul endotelial relaxant
ELISA Enzyme Linked Immunosorbent Assay
FA 1. acid folic; 2. fosfataza alcalin
FIGO Federaia Internaional de Ginecologie i Obstetric
FIV fertilizare in vitro
FSH hormonul foliculostimulant
g gram
g/l gram /litru
g/or gram /or
G-6-PD glucozo-6-fosfataz
GINA Global Initiative in Asthma
GN glomerulonefrit
gr., Gr. grad
Gy gray
H nlime
h or
H
2
O ap
HAV hepatit viral A
Hb hemoglobin
HbS hemoglobina drepanocitelor
HBV hepatit viral B
hCG, HGC hormonul gonadotropin corionic
HCV hepatit viral C
HDV hepatit viral delta
HELLP sindrom - Hemolysis - hemoliz, Elevated Liver enzymes - activitatea mrit a enzimelor
hepatice, Low Platelet count - trombocitopenie
HIV/SIDA virusul imunodefcienei umane dobndite
HLA human leukocyte antigen
hLP hormonul lactogenul placentar
HP hemoragiile post-partum
HPV infeciile cu papilomavirus
Ht hematocrit
HTA hipertensiunea arterial
I infuzie lichidian
IC indicele de conductan placentar
ICSI injectarea intracitoplasmatic a spermatozoizilor
ID diastolic
IG imunoglobulin
IL interleuchin
ILA indicele de lichid amniotic
ImI indicele de impendan (Erskine- Ritchie)
IP indicele de pulsalitate (Gosling)
IR indicele de rezisten (Pourcelot)
IRA insufcien renal acut
IRC insufcien renal cronic
IRVA infecie respiratorie viral acut
I indicele de oc
ISD indicele Stuart Drumm
K+ kaliu, potasiu
kcal/kg kilocalorii /kilogram
kcal/zi kilocalorii /zi
kg kilogram
L lecitin
l litru
LA lichid amniotic
LB litiaz biliar
LCC lungimea cranio-caudal
LDL low-density-lipoprotein, lipoproteine de densitate joas
LES lupus eritematos de sistem (sistemic)
OBSTETRIC PATOLOGIC
17
LF lungimea femurului
LH hormon luteinizant
LLC leucemie cronic limfocitar
LMC leucemie cronic mieloid
LMWH preparate heparinice cu greutate molecular mic
LP lactogen placentar
LTN leziunile trofoblastice neclasifcate
M mas
m milimetru
cg microgram
MESA aspiraia microepididimal a spermatozoizilor sub controlul microscopului
mg miligram
mg /zi miligram /zi
mg% miligram%
mg/kg/min miligram /kilogram /minut
MgSO4 sulfat de magneziu
MH mola hidatiform
MHC mola hidatiform complet
MHP mola hidatiform parial
MI mola invaziv
min minut
MIUF moartea intrauterin a ftului
Ml, mL mililitru
Mm Hg milimetri ai coloanei de hidrargium (mercur)
mmol/l milimoli /litru
MODS sindromul de disfuncie organic multipl
MST maladiile sexual transmisibile
MTX metotrexat
MU miom uterin
Na+ natriu
NH National Institute of Health
nm nanometru
NO oxid de azot
NP natere prematur
NVG nauseea i voma gravidelor
NYHA New York Heart Association
O2 oxigen
OA oligoamnios
OC operaie cezarian
OI ocluzie intestinal
OMS Organizaia Mondial a Sntii
P 1. perfuzie; 2. pomp cardiac
PA pancreatit acut
PCO2 presiunea parial a bioxidului de carbon
PCR reacia de polimerizare n lan
PESA aspiraia epididimal percutanee cu ajutorul unui ac subire
PG, Pg 1. prostaglandin; 2. fosfatidilglicerol
PGE1 gemeprost, misoprostol (cytotec)
PGE2 dinoproston, prepidil
PH polihidramnios
Ph tratament medicamentos; medicaie
PI fosfatidilinosit
PIF proflul indexului de frecven (Campbell)
PLAP fosfataz alcalin placentar
PNA pielonefrit acut
PNC pielonefrit cronic
pO2 presiunea parial a oxigenului
PP 1. placenta praevia; 2. prezentaie pelvian; 3. psihoz postnatal
PTU propiltiouracil
18
PVC presiune venoas central
PVM pung vertical maxim
PVN per vias naturalis
rad razi
RD retinopatie diabetic
RDIU retardul de dezvoltare intrauterin a ftului
Rh factor rezus
RMN rezonan magnetic nuclear
RPMA ruperea prematur a membranelor amniotice
RU 486 mifepriston, mifprex
s, sec. secund
S 1. sfngomielin; 2. variaia frecvenei sistolice maxime; 3. terapie specifc
SAFL sindrom antifosfolipidic
spt. sptmni
SBF scorul biofzical
SCN sistemul nervos central
SGB streptococul grupei B
SHBG sex hormone binding globulin
SI segment inferior
sol. soluie
SRIS sindromul de rspuns infamator sistemic
beta
STH hormon somatotrop
Strp. streptococ
T3 triiodtironin
T4 tiroxin
TA tensiune arterial
T-AT-III trombin-antitrombin-III
TBA albumin
TBG thyroid binding globulin, globulin
TBPA prealbumin
TC tomografe computerizat
TEAP tromboembolia arterei pulmonare
TNS testul non-stres
TO tumori ovariene
TP tuberculoz pulmonar
TTPA timp tromboplastinic parial activat
TTSP tumoare trofoblastic de sit placentar
TVP tromboza venelor profunde
UA unitate de aciune
UI unitate internaional
USG ultrasonografe
V ventilaie
VDRL Veneral Disease Research Laboratories
VEC versiunea extern cefalic
VG vrst de gestaie/gestaional
VHS virusul Herpes Simplex
VLA volumul lichidului amniotic
VSC volumul sngelui circulant
VSH viteza de sedimentare a hematiilor
X cromozomul X
Y cromozomul Y
-hGC subunitatea beta a hormonului gonadotropin corionic
-globuline gama-globuline
lungimea de und
g /dl microgram /decilitru
g /zi microgram /zi
OBSTETRIC PATOLOGIC
19
PREFA
S

arcina i naterea ntotdeauna au fost privite ca un proces fziologic.
n acelai timp au avut i un impact pozitiv esenial n acest proces
dezvoltarea rapid a tiinei medicale, inclusiv a obstetricii, perfecionarea
formelor organizatorice, implementarea noilor metode de diagnostic i trata-
ment. Cu toate acestea, sarcina i naterea prezint uneori un risc sporit
pentru sntatea mamei i a copilului. n lume, sunt nregistrate anual peste
130 mln. de nateri, pierderile reproductive anuale constituind 500 000 de
decese materne i 6 mln. de decese perinatale drept consecin a unor cauze
cu infuen direct sau indirect.
Riscul de deces variaz de la 1:20 n rile n curs de dezvoltare vis-a-vis
de 1:10000 n majoritatea rilor industrial dezvoltate.
Analiza deceselor materne i perinatale denot c multe din aceste viei
ar f putut f salvate dac realizrile tiinei medicale i practice ar f fost im-
plementate la timp i aplicate judicios. Or, se tie c utilizarea neraional a
tehnologiilor noi poate duce la apariia unor complicaii cu consecine grave
att pentru mam, ct i pentru ft.
n anul 2006 a ieit de sub tipar volumul I al manualului de Obstetric,
Bazele obstetricii fziologice.
Prezenta lucrare este consacrat patologiei obstetricale i prezint
volumul II al acestui manual. El conine 29 capitole viznd toate formele
patologice ale obstetricii. La expunerea materiei au fost folosite experiena
autorilor i rezultatele tiinei din ultimii ani nu numai n domeniul obs-
tetricii, dar i al altor discipline medicale fr de care ar f imposibil dez-
voltarea acesteia.
n manual sunt expuse cele mai raionale forme de conduit a sarcinii i
naterii n caz de gestoze tardive, retard de dezvoltare intrauterin a ftului,
prezentaii fesiere, ruperea prenatal a pungii amniotice, macrosomie fetal;
sunt prezentate procedeele de resuscitare a nou-nscutului, aa-zisele pa-
tologii care pe parcursul ultimelor decenii au fost obiectul unor discuii am-
ple. De pe poziii noi este elucidat problema operaiei cezariene.
n acest volum au fost incluse capitole noi fa de alte manuale, cum ar
f: patologia chirurgical n sarcin, sarcina medical asistat, aspecte psi-
hologice n obstetric, tumorile benigne i maligne ale organelor genitale
feminine i sarcina.
20
Pentru facilitarea nsuirii materiei, manualul este nzestrat cu un bogat
material ilustrativ (grafce, tabele) i algoritme de conduit.
Dezvoltarea tiinei medicale cere revizuirea periodic a programelor de
studiu universitare i la compartimentul obstetric.
Un rol important n pregtirea specialitilor n cadrul universitii
aparine programelor de pregtire a studenilor i rezidenilor. Ele necesit
s fe permanent revzute n conformitate cu progresul tiinei medicale.
Sperm c acest volum va rspunde interesului i necesitilor de instruire
ale noii generaii de studeni, rezideni, medici de familie i va oferi soluii
efciente n domeniul obstetricii contemporane orientate spre mbuntirea
indicatorilor sntii reproductive.
Gh. PALADI
OBSTETRIC PATOLOGIC
21
PREFACE
P
regnancy and birth have always been considered as a physiological
process. Unfortunately, in spite of the quick development of the
medical science, including obstetrics, improvement of the organization,
implementation of the new methods of diagnostics and treatment, up to
present time pregnancy and birth present a high risk for the health of mother
and child. Each year more than 130 million births are registered worldwide,
but annual reproductive losses constitute 500 000 maternal births and 6
million perinatal deaths as a consequence of the causes of direct and indirect
infuence.
The risk of death differs from 1:20 in the developing countries and 1:10000
in the majority of the industrial developed countries.
The analysis of the maternal and perinatal deaths denotes that many
of these lives could be saved, if the achievements of the medical science
and practice would be have been implemented duly and used rationally.
However, irrational use of the new technologies can lead to the appearance
of complications with the serious complications both for the mother and the
fetus.
In 2006 Basics of Physiological Obstetrics Vol. I was published.
Volume II is devoted to the obstetrical pathology and contains 27 chapters,
comprising all pathological forms of obstetrics. The authors experience and
the science results of the recent years not only in obstetrics, but in the other
medical disciplines, without which the further development of this discipline
would be impossible, have been applied.
The manual describes the most rational forms of pregnancy and birth
behavior in the case of tardive gestosis, retard in the fetus intrauterine
development, breech delivery, prenatal rupture of the amniotic sac, fetal
macrosomia, resuscitation of the new born child, so-called pathologies, which
were subject to numerous discussions in the recent decades. The problem of
the cesarean operation has been elucidated from the new points of view.
This volume includes new chapters, such as surgical pathology in
pregnancy, medically assisted pregnancy, psychological aspects in obstetrics,
benign and malign tumors of the female genital organs and pregnancy.
To facilitate studying of the material, the manual comprises the rich
illustrative material (graphs, tables) and the behavior algorithms.
22
The development of the medical science demands further revision of
obstetrics in the university curricula.
The curricula of students and residents training play an import role in the
training of specialists at the university. They need to be renewed permanently
in accordance with the progress of the medical science.
We hope that this volume responds to interest and needs of the new
generation of students, residents, family doctors and meets the requirements
of the modern obstetrics oriented to the improvement of the reproductive
health indexes.
Gh. PALADI

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OBSTETRIC PATOLOGIC

1 MINISTERUL OCROTIRII S+N+T+|II AL REPUBLICII MOLDOVA

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