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Биологическая обратная связь в реабилитации женщин с дисфункцией тазового дна: урогинекологические и сексологические аспекты
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Аннотация
Активное долголетие и работоспособность современных женщин делают актуальной проблему эффективной реабилитации пациенток с дисфункцией тазового дна, сохранения высокого уровня качества жизни при урогинекологических заболеваниях. В представленном обзоре рассматриваются терапевтические возможности тренировки мышц тазового дна с использованием биологической обратной связи (БОС) как при симптомах недержания мочи, так и для улучшения сексуального функционирования женщин. Обсуждается тактика, эффективность разных лечебно-реабилитационных методик, используемых при сексуальных дисфункциях, ассоциированных с недержанием мочи. В статье показаны перспективы использования БОС-тренинга в урогинекологии, а также обозначена необходимость дополнительных знаний в области женского сексуального здоровья для специалистов.
Ключевые слова: недержание мочи, сексуальная дисфункция, тренировка мышц тазового дна, биологическая обратная связь.
Ключевые слова: недержание мочи, сексуальная дисфункция, тренировка мышц тазового дна, биологическая обратная связь.
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Active ageing and operability of the modern women makes actual the problem of effective rehabilitation of patients with pelvic floor dysfunction, to maintain a high level the quality of life. The given review considers the therapeutic possibilities of adding biofeedback to pelvic floor muscle training to treat incontinence and to improve women's sexual functioning. The tactics and the effectiveness of various techniques the treatment and the rehabilitation are discussed, that are used for sexual dysfunction, associated with incontinence. The article describes the prospects using biofeedback in urogynecology and highlight need for more additional knowledge from experts in the field of women's sexual health.
Key words: sexual dysfunction, pelvic floor dysfunction, urinary incontinence, pelvic floor muscle training, biofeedback.
Полный текст
Список литературы
1. Аполихина И.А. Клиническая эпидемиология, дифференциальная диагностика и консервативное лечение недержания мочи у женщин. Автореф. дис. ... д-ра мед. наук. М., 2006.
2. Bump RC. Discussion: Epidemiology of urinary incontinence. Urology 1997; 50 (6A): 15–6.
3. Bulmer P, Abrams P. The Overactive Bladder. Rev Contemp Pharmacother 2000; 11: 1–11.
4. Лоран О.Б. Эпидемиология, этиология, патогенез, диагностика недержания мочи. Пленум Правления Российского общества урологов. Материалы. М., 2001; с. 21–41.
5. Пушкарь Д.Ю. Диагностика и лечение сложных форм недержания мочи у женщин. Акуш. и гинекол. 2000; 1: 3–7.
6. Kammerer-Doak D. Assessment of sexual function in women with pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct 2009;
20 (Suppl. 1): 45–50.
7. Pauls RN, Kleeman SD, Segal JL et al. Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16: 460–7.
8. Pauls RN, Segal JL, Silva WA et al. Sexual function in patients presenting to a urogynecology practice. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (6): 576–80.
9. Vierhout ME, Gianotten WL. Mechanisms of urine loss during sexual activity. Eur J Obstet Gynecol Reprod Biol 1993; 52: 45–7.
10. Temml C, Haidinger G, Schmidbauer J et al. Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life. Neurourol Urodyn 2000; 19: 259–71.
11. Oh SJ, Ku JH, Choo MS et al. Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder. Int J Urol 2008;15 (1): 62–7.
12. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994; p. 511–8.
13. Frank JE, Mistretta P, Will J. Diagnosis and treatment of female sexual dysfunction. Am Fam Physician 2009; 79 (3): 180.
14. Van Lankveld JJ, Weijenborg PT, ter Kuile MM. Psychologic profiles of and sexual function in women with vulvar vestibulitis and their partners. Obstet Gynecol 1996; 88: 65–70.
15. Kuhn A, Bapst D, Stadlmayr W et al. Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Fertil Steril 2009; 91 (5): 1914–8.
16. Thakar R, Manyonda I, Stanton SL et al. Bladder, bowel and sexual function after hysterectomy for benign conditions. Br J Obstet Gynaecol 1997; 104: 983–7.
17. Wyman JF, Harkins SW, Choi SC et al. Psychosocial impact of urinary incontinence in women. Obstet Gynecol 1987; 70: 378–81.
18. Abrams P, Cardozo L, Fall M et al. The Standartisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub-committe of ICS. Neur Urodyn 2002; 21: 167–78.
19. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). In: The Cochrane Collaboration, 2011.
20. Каган И.И., Чемезов С.В. Топографическая анатомия и оперативная хирургия. М.: ГЭОТАР-Медиа, 2011.
21. Neumann PB, Grimmer KA, Deenadayalan Y. Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review. BMC Women’s health 2006; 28: 6–11.
22. Visco AG, Brown JS, Shin GP et al. Annual direct cost of incontinence. Obstet Gynecol 2001; 98: 398.
23. Devillers P, Mauroy B. Rehabilitation of female urinary incontinence. Techniques and indications Prog Urol 1997; 7 (4): 683–93.
24. Mueller N. Keeping the vital pelvic floor healthy. J Active Aging 2005; 35–41.
25. Santacreu M, Fernández-Ballesteros R. Evaluation of a behavioral treatment for female urinary incontinence. Clin Interv Aging 2011; 6: 133–9.
26. Perry JD, Hullet LT. The role of home trainers in Kegel’s Exercise Program for the treatment of incontinence. Ostomy. Wound Management 1990; 30: 51.
27. Schwartz M. Biofeedback: A Practitioner's Guide, Second Edition, 1995.
28. Herderschee R, Hay-Smith EJ, Herbison GP et al. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011; 7.
29. Богданов О.В., Пинчук Д.Ю., Михайленок Е.Л. Эффективность различных форм сигналов обратной связи в ходе лечебных сеансов ФБУ. Физиология человека. 1990; 16 (1): 13–7.
30. Glazer HI, Laine CD. Pelvic floor muscle biofeedback in the treatment of urinary incontinence: a literature review. Appl Psychophysiol Biofeedback 2006; 31 (3): 187–201.
31. Балан В.Е., Ермакова Е.И., Ковалева Л.А. Консервативная терапия недержания мочи. Лечащий врач. 2007; 10: 12–6.
32. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010; 1: CD005654.
33. Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sex Med 2007; 4 (1): 4–13.
34. Piassarolli VP, Hardy E, Andrade NF et al. Pelvic floor muscle training in female sexual dysfunctions. Rev Bras Ginecol Obstet 2010; 32 (5): 234–40.
35. Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function in women with stress urinary incontinence. Int J Urogynecol Dysfunct pelvic floor 2008; 19 (3): 401–6.
36. Capelini MV, Riccetto CL, Dambros M et al. Pelvic floor exercises with biofeedback for stress urinary incontinence. Int Braz J Urol 2006; 32: 462–8.
37. Rivalta M, Sighinolfi MC et al. Sexual Function and Quality of Life in Women with Urinary Incontinence Treated by a Complete Pelvic Floor Rehabilitation Program (Biofeedback, Functional Electrical Stimulation, Pelvic Floor Muscles Exercises, and Vaginal Cones). J Sex Med 2010; 7 (3): 1200–8.
38. Bergeron S, Binik YM, Khalifé S et al A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001; 91: 297–306.
39. Danielsson I, Torstensson T, Brodda-Jansen G, Bohm-Starke N. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol 2006; 85: 1360–7.
40. Thompson JM. Tension myalgia as a diagnosis at the Mayo Clinic and its relationship to fibrositis, fibromyalgia and myofascial pain syndrome. Mayo Clin Proc 1990; 65: 1237–48.
41. Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain related sexual dysfunction. J Sex Med 2008; 5: 513–23.
2. Bump RC. Discussion: Epidemiology of urinary incontinence. Urology 1997; 50 (6A): 15–6.
3. Bulmer P, Abrams P. The Overactive Bladder. Rev Contemp Pharmacother 2000; 11: 1–11.
4. Лоран О.Б. Эпидемиология, этиология, патогенез, диагностика недержания мочи. Пленум Правления Российского общества урологов. Материалы. М., 2001; с. 21–41.
5. Пушкарь Д.Ю. Диагностика и лечение сложных форм недержания мочи у женщин. Акуш. и гинекол. 2000; 1: 3–7.
6. Kammerer-Doak D. Assessment of sexual function in women with pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct 2009;
20 (Suppl. 1): 45–50.
7. Pauls RN, Kleeman SD, Segal JL et al. Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16: 460–7.
8. Pauls RN, Segal JL, Silva WA et al. Sexual function in patients presenting to a urogynecology practice. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (6): 576–80.
9. Vierhout ME, Gianotten WL. Mechanisms of urine loss during sexual activity. Eur J Obstet Gynecol Reprod Biol 1993; 52: 45–7.
10. Temml C, Haidinger G, Schmidbauer J et al. Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life. Neurourol Urodyn 2000; 19: 259–71.
11. Oh SJ, Ku JH, Choo MS et al. Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder. Int J Urol 2008;15 (1): 62–7.
12. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994; p. 511–8.
13. Frank JE, Mistretta P, Will J. Diagnosis and treatment of female sexual dysfunction. Am Fam Physician 2009; 79 (3): 180.
14. Van Lankveld JJ, Weijenborg PT, ter Kuile MM. Psychologic profiles of and sexual function in women with vulvar vestibulitis and their partners. Obstet Gynecol 1996; 88: 65–70.
15. Kuhn A, Bapst D, Stadlmayr W et al. Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Fertil Steril 2009; 91 (5): 1914–8.
16. Thakar R, Manyonda I, Stanton SL et al. Bladder, bowel and sexual function after hysterectomy for benign conditions. Br J Obstet Gynaecol 1997; 104: 983–7.
17. Wyman JF, Harkins SW, Choi SC et al. Psychosocial impact of urinary incontinence in women. Obstet Gynecol 1987; 70: 378–81.
18. Abrams P, Cardozo L, Fall M et al. The Standartisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub-committe of ICS. Neur Urodyn 2002; 21: 167–78.
19. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). In: The Cochrane Collaboration, 2011.
20. Каган И.И., Чемезов С.В. Топографическая анатомия и оперативная хирургия. М.: ГЭОТАР-Медиа, 2011.
21. Neumann PB, Grimmer KA, Deenadayalan Y. Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review. BMC Women’s health 2006; 28: 6–11.
22. Visco AG, Brown JS, Shin GP et al. Annual direct cost of incontinence. Obstet Gynecol 2001; 98: 398.
23. Devillers P, Mauroy B. Rehabilitation of female urinary incontinence. Techniques and indications Prog Urol 1997; 7 (4): 683–93.
24. Mueller N. Keeping the vital pelvic floor healthy. J Active Aging 2005; 35–41.
25. Santacreu M, Fernández-Ballesteros R. Evaluation of a behavioral treatment for female urinary incontinence. Clin Interv Aging 2011; 6: 133–9.
26. Perry JD, Hullet LT. The role of home trainers in Kegel’s Exercise Program for the treatment of incontinence. Ostomy. Wound Management 1990; 30: 51.
27. Schwartz M. Biofeedback: A Practitioner's Guide, Second Edition, 1995.
28. Herderschee R, Hay-Smith EJ, Herbison GP et al. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011; 7.
29. Богданов О.В., Пинчук Д.Ю., Михайленок Е.Л. Эффективность различных форм сигналов обратной связи в ходе лечебных сеансов ФБУ. Физиология человека. 1990; 16 (1): 13–7.
30. Glazer HI, Laine CD. Pelvic floor muscle biofeedback in the treatment of urinary incontinence: a literature review. Appl Psychophysiol Biofeedback 2006; 31 (3): 187–201.
31. Балан В.Е., Ермакова Е.И., Ковалева Л.А. Консервативная терапия недержания мочи. Лечащий врач. 2007; 10: 12–6.
32. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010; 1: CD005654.
33. Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sex Med 2007; 4 (1): 4–13.
34. Piassarolli VP, Hardy E, Andrade NF et al. Pelvic floor muscle training in female sexual dysfunctions. Rev Bras Ginecol Obstet 2010; 32 (5): 234–40.
35. Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function in women with stress urinary incontinence. Int J Urogynecol Dysfunct pelvic floor 2008; 19 (3): 401–6.
36. Capelini MV, Riccetto CL, Dambros M et al. Pelvic floor exercises with biofeedback for stress urinary incontinence. Int Braz J Urol 2006; 32: 462–8.
37. Rivalta M, Sighinolfi MC et al. Sexual Function and Quality of Life in Women with Urinary Incontinence Treated by a Complete Pelvic Floor Rehabilitation Program (Biofeedback, Functional Electrical Stimulation, Pelvic Floor Muscles Exercises, and Vaginal Cones). J Sex Med 2010; 7 (3): 1200–8.
38. Bergeron S, Binik YM, Khalifé S et al A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001; 91: 297–306.
39. Danielsson I, Torstensson T, Brodda-Jansen G, Bohm-Starke N. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol 2006; 85: 1360–7.
40. Thompson JM. Tension myalgia as a diagnosis at the Mayo Clinic and its relationship to fibrositis, fibromyalgia and myofascial pain syndrome. Mayo Clin Proc 1990; 65: 1237–48.
41. Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain related sexual dysfunction. J Sex Med 2008; 5: 513–23.
________________________________________________
1. Аполихина И.А. Клиническая эпидемиология, дифференциальная диагностика и консервативное лечение недержания мочи у женщин. Автореф. дис. ... д-ра мед. наук. М., 2006.
2. Bump RC. Discussion: Epidemiology of urinary incontinence. Urology 1997; 50 (6A): 15–6.
3. Bulmer P, Abrams P. The Overactive Bladder. Rev Contemp Pharmacother 2000; 11: 1–11.
4. Лоран О.Б. Эпидемиология, этиология, патогенез, диагностика недержания мочи. Пленум Правления Российского общества урологов. Материалы. М., 2001; с. 21–41.
5. Пушкарь Д.Ю. Диагностика и лечение сложных форм недержания мочи у женщин. Акуш. и гинекол. 2000; 1: 3–7.
6. Kammerer-Doak D. Assessment of sexual function in women with pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct 2009;
20 (Suppl. 1): 45–50.
7. Pauls RN, Kleeman SD, Segal JL et al. Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16: 460–7.
8. Pauls RN, Segal JL, Silva WA et al. Sexual function in patients presenting to a urogynecology practice. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (6): 576–80.
9. Vierhout ME, Gianotten WL. Mechanisms of urine loss during sexual activity. Eur J Obstet Gynecol Reprod Biol 1993; 52: 45–7.
10. Temml C, Haidinger G, Schmidbauer J et al. Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life. Neurourol Urodyn 2000; 19: 259–71.
11. Oh SJ, Ku JH, Choo MS et al. Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder. Int J Urol 2008;15 (1): 62–7.
12. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994; p. 511–8.
13. Frank JE, Mistretta P, Will J. Diagnosis and treatment of female sexual dysfunction. Am Fam Physician 2009; 79 (3): 180.
14. Van Lankveld JJ, Weijenborg PT, ter Kuile MM. Psychologic profiles of and sexual function in women with vulvar vestibulitis and their partners. Obstet Gynecol 1996; 88: 65–70.
15. Kuhn A, Bapst D, Stadlmayr W et al. Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Fertil Steril 2009; 91 (5): 1914–8.
16. Thakar R, Manyonda I, Stanton SL et al. Bladder, bowel and sexual function after hysterectomy for benign conditions. Br J Obstet Gynaecol 1997; 104: 983–7.
17. Wyman JF, Harkins SW, Choi SC et al. Psychosocial impact of urinary incontinence in women. Obstet Gynecol 1987; 70: 378–81.
18. Abrams P, Cardozo L, Fall M et al. The Standartisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub-committe of ICS. Neur Urodyn 2002; 21: 167–78.
19. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). In: The Cochrane Collaboration, 2011.
20. Каган И.И., Чемезов С.В. Топографическая анатомия и оперативная хирургия. М.: ГЭОТАР-Медиа, 2011.
21. Neumann PB, Grimmer KA, Deenadayalan Y. Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review. BMC Women’s health 2006; 28: 6–11.
22. Visco AG, Brown JS, Shin GP et al. Annual direct cost of incontinence. Obstet Gynecol 2001; 98: 398.
23. Devillers P, Mauroy B. Rehabilitation of female urinary incontinence. Techniques and indications Prog Urol 1997; 7 (4): 683–93.
24. Mueller N. Keeping the vital pelvic floor healthy. J Active Aging 2005; 35–41.
25. Santacreu M, Fernández-Ballesteros R. Evaluation of a behavioral treatment for female urinary incontinence. Clin Interv Aging 2011; 6: 133–9.
26. Perry JD, Hullet LT. The role of home trainers in Kegel’s Exercise Program for the treatment of incontinence. Ostomy. Wound Management 1990; 30: 51.
27. Schwartz M. Biofeedback: A Practitioner's Guide, Second Edition, 1995.
28. Herderschee R, Hay-Smith EJ, Herbison GP et al. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011; 7.
29. Богданов О.В., Пинчук Д.Ю., Михайленок Е.Л. Эффективность различных форм сигналов обратной связи в ходе лечебных сеансов ФБУ. Физиология человека. 1990; 16 (1): 13–7.
30. Glazer HI, Laine CD. Pelvic floor muscle biofeedback in the treatment of urinary incontinence: a literature review. Appl Psychophysiol Biofeedback 2006; 31 (3): 187–201.
31. Балан В.Е., Ермакова Е.И., Ковалева Л.А. Консервативная терапия недержания мочи. Лечащий врач. 2007; 10: 12–6.
32. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010; 1: CD005654.
33. Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sex Med 2007; 4 (1): 4–13.
34. Piassarolli VP, Hardy E, Andrade NF et al. Pelvic floor muscle training in female sexual dysfunctions. Rev Bras Ginecol Obstet 2010; 32 (5): 234–40.
35. Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function in women with stress urinary incontinence. Int J Urogynecol Dysfunct pelvic floor 2008; 19 (3): 401–6.
36. Capelini MV, Riccetto CL, Dambros M et al. Pelvic floor exercises with biofeedback for stress urinary incontinence. Int Braz J Urol 2006; 32: 462–8.
37. Rivalta M, Sighinolfi MC et al. Sexual Function and Quality of Life in Women with Urinary Incontinence Treated by a Complete Pelvic Floor Rehabilitation Program (Biofeedback, Functional Electrical Stimulation, Pelvic Floor Muscles Exercises, and Vaginal Cones). J Sex Med 2010; 7 (3): 1200–8.
38. Bergeron S, Binik YM, Khalifé S et al A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001; 91: 297–306.
39. Danielsson I, Torstensson T, Brodda-Jansen G, Bohm-Starke N. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol 2006; 85: 1360–7.
40. Thompson JM. Tension myalgia as a diagnosis at the Mayo Clinic and its relationship to fibrositis, fibromyalgia and myofascial pain syndrome. Mayo Clin Proc 1990; 65: 1237–48.
41. Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain related sexual dysfunction. J Sex Med 2008; 5: 513–23.
Авторы
Н.Н.Стеняева1, И.А.Аполихина1, 2, Д.Ф.Хритинин2
1. ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава РФ, Москва;
2. ФППОВ ГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава РФ
1. ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава РФ, Москва;
2. ФППОВ ГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава РФ
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N.N.Stenyaeva, I.A.Apolikhina, D.F.Khritinin
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