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Некрасивая шейка матки. Что делать? (кольпоскопическая картина без признаков ВПЧ-ассоциированного поражения)
Некрасивая шейка матки. Что делать? (кольпоскопическая картина без признаков ВПЧ-ассоциированного поражения)
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Многие изменения на шейке матки могут быть не связаны с цервикальной интраэпителиальной неоплазией и риском возникновения рака. Вопрос о тактике и целесообразности лечения при этих состояниях часто является дискуссионным. Несколько полезных клинических рекомендаций по оптимальному ведению таких пациенток представлены в данной статье.
Ключевые слова: кольпоскопия, эктопия шейки матки, эктропион, цервикальный полип, эндометриоз шейки матки, врожденная зона трансформации, атрофия.
Key words: colposcopy, ectropion cervix uteri, cervical polyp, endometriosis, congenital transformation zone, vaginal atrophy, leukoplakia
Ключевые слова: кольпоскопия, эктопия шейки матки, эктропион, цервикальный полип, эндометриоз шейки матки, врожденная зона трансформации, атрофия.
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Key words: colposcopy, ectropion cervix uteri, cervical polyp, endometriosis, congenital transformation zone, vaginal atrophy, leukoplakia
Полный текст
Список литературы
1. Bornstein J, Bentley J, Bösze P et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 2012; 120 (1): 166–72.
2. Кондриков Н.И. Патология матки. М.: Практическая медицина, 2008; с 18–9.
3. Schnatz PF, Ricci S, O’Sullivan DM. Cervical polyps in postmenopausal women: is there a difference in risk? Menopause 2009; 16 (3): 524–8.
4. Jefferies JA, Robboy SJ, O’Brien PC et al. Structural anomalies of the cervix and vagina in women enrolled in the Diethylstilbestrol Adenosis (DESAD) Project. Am J Obstet Gynecol 1984; 148 (1): 59–66.
5. Crews D, McLachlan JA. Epigenetics, evolution, endocrine disruption, health, and disease. Endocrinology 2006; 147 (Suppl. 6): S4–10.
6. MacKenzie IZ, Naish C, Rees CM, Manek S. Why remove all cervical polyps and examine them histologically? Br J Obstet Gynaecol 2009; 116 (8): 1127–9. [Epub 2009 Apr 15] doi: 10.1111/j.1471-0528.2009.02169.x.
7. Younis MT, Iram S, Anwar B, Ewies AA. Women with asymptomatic cervical polyps may not need to see a gynaecologist or have them removed: an observational retrospective study of 1126 cases. Eur J Obstet Gynecol Reprod Biol 2010; 150 (2): 190–4.
8. Pixley E. Morphology of the fetal and prububertal cervicovaginal epithelium. In: The Cervix. Eds J.A.Jordan and A.Singer. London–Phyladelphia–Toronto, 1976; p. 75–87.
9. Critchlow CW, Wolner-Hanssen P, Eschenbach DA et al. Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching. Am J Obstet Gynecol 1995; 173 (2): 534–43.
10. Goldacre MJ, Loudon N, Watt B et al. Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic. Br Med J 1978; 1 (6115): 748–50.
11. Hwang LY, Ma Y, Moscicki AB. Factors that influence the rate of epithelial maturation in the cervix of healthy young women. J Adolescent Health 2008; 42: 2.
12. Vanrompay D, Hoang TQ, De Vos L et al. Specific-pathogen-free pigs as an animal model for studying Chlamydia trachomatis genital infection. Infect Immunol 2005; 73 (12): 8317–21.
13. Dunne EF, Unger ER, Sternberg M et al. Prevalence of HPV infection among females in the United States. JAMA 2007; 297 (8): 813–9.
14. Шипулина О.Ю., Михеева И.В., Романюк Т.Н. и др. Оценка частоты выявления ИППП и вирусов папилломы человека высокого и низкого онкогенного риска среди девушек-подростков Московской области. Эпидемиология и вакцинопрофилактика. 2011; 6.
15. Hwang LY, Ma Y, Shiboski SC et al. Active squamous metaplasia of the cervical epithelium is associated with subsequent acquisition of human papillomavirus 16 infection among healthy young women. J Infect Dis 2012; 206 (4): 504–11.
16. Струков А.И., Серов В.В. Патологическая анатомия. М.: Медицина, 1995.
17. Hanau CA, Begley N, Bibbo M. Cervical endometriosis: a potential pitfall in the evaluation of glandular cells in cervical smears. Diagn Cytopathol 1997; 16: 274–80.
18. Lundeen SJ, Horwitz CA, Larson CJ, Stanley MW. Abnormal cervicovaginal smears due to endometriosis: A continuing problem. Diagn Cytopathology 2002; 26: 35–40.
19. Symonds DA, Reed TP, Didolkar SM, Graham RR. AGUS in cervical endometriosis. J Reprod Med 1997; 42: 39–43.
20. McDonnell JM, Emens JM, Jordan JA. The congenital cervicovaginal transformation zone in sexually active young women. Br J Obstet Gynaecol 1984; 91 (6): 580–4.
21. Фириченко С.В., Манухин И.Б., Минкина Г.Н., Фадеева Е.А. Расширенная биопсия шейки матки во время беременности: преимущества и безопасность. Проблемы репродукции. 2012; 1: 79–84.
22. Nohr B, Tabor A et al. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery. Acta Obstet Gynecol Scand 2007; 86 (5): 596–603.
23. Arbyn M, Kyrgiou M. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008; 337: a1284.
24. Acharya G, Kjeldberg I et al. Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia. Arch Gynecol Obstet 2005; 272 (2): 109–12.
25. Althuisius SM, Schornagel IJ et al. Loop electrosurgical excision procedure of the cervix and time of delivery in subsequent pregnancy. 2001; 72 (1): 31–4.
26. Sadler L, Saftlas A, Wang W et al. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004; 291: 2100–6.
27. Castanon A, Brocklehurst P, Evans H et al. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study. BMJ 2012; 34–5.
28. Фириченко С.В., Манухин И.Б., Минкина Г.Н. и др. Эксцизионное лечение цервикальной интраэпителиальной неоплазии и риск преждевременных родов. Проблемы репродукции. 2012; 4: 95–9.
29. Mitchell MF, Schottenfeld D, Tortolero-Luna G et al. Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998; 91: 626–31.
30. Gentry DJ et al. The effects of loop excision of the transformation zone on cervical length: implications for pregnancy. Am J Obstet Gynecol 2000; 182 (3): 516–20.
2. Кондриков Н.И. Патология матки. М.: Практическая медицина, 2008; с 18–9.
3. Schnatz PF, Ricci S, O’Sullivan DM. Cervical polyps in postmenopausal women: is there a difference in risk? Menopause 2009; 16 (3): 524–8.
4. Jefferies JA, Robboy SJ, O’Brien PC et al. Structural anomalies of the cervix and vagina in women enrolled in the Diethylstilbestrol Adenosis (DESAD) Project. Am J Obstet Gynecol 1984; 148 (1): 59–66.
5. Crews D, McLachlan JA. Epigenetics, evolution, endocrine disruption, health, and disease. Endocrinology 2006; 147 (Suppl. 6): S4–10.
6. MacKenzie IZ, Naish C, Rees CM, Manek S. Why remove all cervical polyps and examine them histologically? Br J Obstet Gynaecol 2009; 116 (8): 1127–9. [Epub 2009 Apr 15] doi: 10.1111/j.1471-0528.2009.02169.x.
7. Younis MT, Iram S, Anwar B, Ewies AA. Women with asymptomatic cervical polyps may not need to see a gynaecologist or have them removed: an observational retrospective study of 1126 cases. Eur J Obstet Gynecol Reprod Biol 2010; 150 (2): 190–4.
8. Pixley E. Morphology of the fetal and prububertal cervicovaginal epithelium. In: The Cervix. Eds J.A.Jordan and A.Singer. London–Phyladelphia–Toronto, 1976; p. 75–87.
9. Critchlow CW, Wolner-Hanssen P, Eschenbach DA et al. Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching. Am J Obstet Gynecol 1995; 173 (2): 534–43.
10. Goldacre MJ, Loudon N, Watt B et al. Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic. Br Med J 1978; 1 (6115): 748–50.
11. Hwang LY, Ma Y, Moscicki AB. Factors that influence the rate of epithelial maturation in the cervix of healthy young women. J Adolescent Health 2008; 42: 2.
12. Vanrompay D, Hoang TQ, De Vos L et al. Specific-pathogen-free pigs as an animal model for studying Chlamydia trachomatis genital infection. Infect Immunol 2005; 73 (12): 8317–21.
13. Dunne EF, Unger ER, Sternberg M et al. Prevalence of HPV infection among females in the United States. JAMA 2007; 297 (8): 813–9.
14. Шипулина О.Ю., Михеева И.В., Романюк Т.Н. и др. Оценка частоты выявления ИППП и вирусов папилломы человека высокого и низкого онкогенного риска среди девушек-подростков Московской области. Эпидемиология и вакцинопрофилактика. 2011; 6.
15. Hwang LY, Ma Y, Shiboski SC et al. Active squamous metaplasia of the cervical epithelium is associated with subsequent acquisition of human papillomavirus 16 infection among healthy young women. J Infect Dis 2012; 206 (4): 504–11.
16. Струков А.И., Серов В.В. Патологическая анатомия. М.: Медицина, 1995.
17. Hanau CA, Begley N, Bibbo M. Cervical endometriosis: a potential pitfall in the evaluation of glandular cells in cervical smears. Diagn Cytopathol 1997; 16: 274–80.
18. Lundeen SJ, Horwitz CA, Larson CJ, Stanley MW. Abnormal cervicovaginal smears due to endometriosis: A continuing problem. Diagn Cytopathology 2002; 26: 35–40.
19. Symonds DA, Reed TP, Didolkar SM, Graham RR. AGUS in cervical endometriosis. J Reprod Med 1997; 42: 39–43.
20. McDonnell JM, Emens JM, Jordan JA. The congenital cervicovaginal transformation zone in sexually active young women. Br J Obstet Gynaecol 1984; 91 (6): 580–4.
21. Фириченко С.В., Манухин И.Б., Минкина Г.Н., Фадеева Е.А. Расширенная биопсия шейки матки во время беременности: преимущества и безопасность. Проблемы репродукции. 2012; 1: 79–84.
22. Nohr B, Tabor A et al. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery. Acta Obstet Gynecol Scand 2007; 86 (5): 596–603.
23. Arbyn M, Kyrgiou M. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008; 337: a1284.
24. Acharya G, Kjeldberg I et al. Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia. Arch Gynecol Obstet 2005; 272 (2): 109–12.
25. Althuisius SM, Schornagel IJ et al. Loop electrosurgical excision procedure of the cervix and time of delivery in subsequent pregnancy. 2001; 72 (1): 31–4.
26. Sadler L, Saftlas A, Wang W et al. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004; 291: 2100–6.
27. Castanon A, Brocklehurst P, Evans H et al. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study. BMJ 2012; 34–5.
28. Фириченко С.В., Манухин И.Б., Минкина Г.Н. и др. Эксцизионное лечение цервикальной интраэпителиальной неоплазии и риск преждевременных родов. Проблемы репродукции. 2012; 4: 95–9.
29. Mitchell MF, Schottenfeld D, Tortolero-Luna G et al. Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998; 91: 626–31.
30. Gentry DJ et al. The effects of loop excision of the transformation zone on cervical length: implications for pregnancy. Am J Obstet Gynecol 2000; 182 (3): 516–20.
2. Кондриков Н.И. Патология матки. М.: Практическая медицина, 2008; с 18–9.
3. Schnatz PF, Ricci S, O’Sullivan DM. Cervical polyps in postmenopausal women: is there a difference in risk? Menopause 2009; 16 (3): 524–8.
4. Jefferies JA, Robboy SJ, O’Brien PC et al. Structural anomalies of the cervix and vagina in women enrolled in the Diethylstilbestrol Adenosis (DESAD) Project. Am J Obstet Gynecol 1984; 148 (1): 59–66.
5. Crews D, McLachlan JA. Epigenetics, evolution, endocrine disruption, health, and disease. Endocrinology 2006; 147 (Suppl. 6): S4–10.
6. MacKenzie IZ, Naish C, Rees CM, Manek S. Why remove all cervical polyps and examine them histologically? Br J Obstet Gynaecol 2009; 116 (8): 1127–9. [Epub 2009 Apr 15] doi: 10.1111/j.1471-0528.2009.02169.x.
7. Younis MT, Iram S, Anwar B, Ewies AA. Women with asymptomatic cervical polyps may not need to see a gynaecologist or have them removed: an observational retrospective study of 1126 cases. Eur J Obstet Gynecol Reprod Biol 2010; 150 (2): 190–4.
8. Pixley E. Morphology of the fetal and prububertal cervicovaginal epithelium. In: The Cervix. Eds J.A.Jordan and A.Singer. London–Phyladelphia–Toronto, 1976; p. 75–87.
9. Critchlow CW, Wolner-Hanssen P, Eschenbach DA et al. Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching. Am J Obstet Gynecol 1995; 173 (2): 534–43.
10. Goldacre MJ, Loudon N, Watt B et al. Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic. Br Med J 1978; 1 (6115): 748–50.
11. Hwang LY, Ma Y, Moscicki AB. Factors that influence the rate of epithelial maturation in the cervix of healthy young women. J Adolescent Health 2008; 42: 2.
12. Vanrompay D, Hoang TQ, De Vos L et al. Specific-pathogen-free pigs as an animal model for studying Chlamydia trachomatis genital infection. Infect Immunol 2005; 73 (12): 8317–21.
13. Dunne EF, Unger ER, Sternberg M et al. Prevalence of HPV infection among females in the United States. JAMA 2007; 297 (8): 813–9.
14. Шипулина О.Ю., Михеева И.В., Романюк Т.Н. и др. Оценка частоты выявления ИППП и вирусов папилломы человека высокого и низкого онкогенного риска среди девушек-подростков Московской области. Эпидемиология и вакцинопрофилактика. 2011; 6.
15. Hwang LY, Ma Y, Shiboski SC et al. Active squamous metaplasia of the cervical epithelium is associated with subsequent acquisition of human papillomavirus 16 infection among healthy young women. J Infect Dis 2012; 206 (4): 504–11.
16. Струков А.И., Серов В.В. Патологическая анатомия. М.: Медицина, 1995.
17. Hanau CA, Begley N, Bibbo M. Cervical endometriosis: a potential pitfall in the evaluation of glandular cells in cervical smears. Diagn Cytopathol 1997; 16: 274–80.
18. Lundeen SJ, Horwitz CA, Larson CJ, Stanley MW. Abnormal cervicovaginal smears due to endometriosis: A continuing problem. Diagn Cytopathology 2002; 26: 35–40.
19. Symonds DA, Reed TP, Didolkar SM, Graham RR. AGUS in cervical endometriosis. J Reprod Med 1997; 42: 39–43.
20. McDonnell JM, Emens JM, Jordan JA. The congenital cervicovaginal transformation zone in sexually active young women. Br J Obstet Gynaecol 1984; 91 (6): 580–4.
21. Фириченко С.В., Манухин И.Б., Минкина Г.Н., Фадеева Е.А. Расширенная биопсия шейки матки во время беременности: преимущества и безопасность. Проблемы репродукции. 2012; 1: 79–84.
22. Nohr B, Tabor A et al. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery. Acta Obstet Gynecol Scand 2007; 86 (5): 596–603.
23. Arbyn M, Kyrgiou M. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008; 337: a1284.
24. Acharya G, Kjeldberg I et al. Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia. Arch Gynecol Obstet 2005; 272 (2): 109–12.
25. Althuisius SM, Schornagel IJ et al. Loop electrosurgical excision procedure of the cervix and time of delivery in subsequent pregnancy. 2001; 72 (1): 31–4.
26. Sadler L, Saftlas A, Wang W et al. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004; 291: 2100–6.
27. Castanon A, Brocklehurst P, Evans H et al. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study. BMJ 2012; 34–5.
28. Фириченко С.В., Манухин И.Б., Минкина Г.Н. и др. Эксцизионное лечение цервикальной интраэпителиальной неоплазии и риск преждевременных родов. Проблемы репродукции. 2012; 4: 95–9.
29. Mitchell MF, Schottenfeld D, Tortolero-Luna G et al. Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998; 91: 626–31.
30. Gentry DJ et al. The effects of loop excision of the transformation zone on cervical length: implications for pregnancy. Am J Obstet Gynecol 2000; 182 (3): 516–20.
________________________________________________
2. Кондриков Н.И. Патология матки. М.: Практическая медицина, 2008; с 18–9.
3. Schnatz PF, Ricci S, O’Sullivan DM. Cervical polyps in postmenopausal women: is there a difference in risk? Menopause 2009; 16 (3): 524–8.
4. Jefferies JA, Robboy SJ, O’Brien PC et al. Structural anomalies of the cervix and vagina in women enrolled in the Diethylstilbestrol Adenosis (DESAD) Project. Am J Obstet Gynecol 1984; 148 (1): 59–66.
5. Crews D, McLachlan JA. Epigenetics, evolution, endocrine disruption, health, and disease. Endocrinology 2006; 147 (Suppl. 6): S4–10.
6. MacKenzie IZ, Naish C, Rees CM, Manek S. Why remove all cervical polyps and examine them histologically? Br J Obstet Gynaecol 2009; 116 (8): 1127–9. [Epub 2009 Apr 15] doi: 10.1111/j.1471-0528.2009.02169.x.
7. Younis MT, Iram S, Anwar B, Ewies AA. Women with asymptomatic cervical polyps may not need to see a gynaecologist or have them removed: an observational retrospective study of 1126 cases. Eur J Obstet Gynecol Reprod Biol 2010; 150 (2): 190–4.
8. Pixley E. Morphology of the fetal and prububertal cervicovaginal epithelium. In: The Cervix. Eds J.A.Jordan and A.Singer. London–Phyladelphia–Toronto, 1976; p. 75–87.
9. Critchlow CW, Wolner-Hanssen P, Eschenbach DA et al. Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching. Am J Obstet Gynecol 1995; 173 (2): 534–43.
10. Goldacre MJ, Loudon N, Watt B et al. Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic. Br Med J 1978; 1 (6115): 748–50.
11. Hwang LY, Ma Y, Moscicki AB. Factors that influence the rate of epithelial maturation in the cervix of healthy young women. J Adolescent Health 2008; 42: 2.
12. Vanrompay D, Hoang TQ, De Vos L et al. Specific-pathogen-free pigs as an animal model for studying Chlamydia trachomatis genital infection. Infect Immunol 2005; 73 (12): 8317–21.
13. Dunne EF, Unger ER, Sternberg M et al. Prevalence of HPV infection among females in the United States. JAMA 2007; 297 (8): 813–9.
14. Шипулина О.Ю., Михеева И.В., Романюк Т.Н. и др. Оценка частоты выявления ИППП и вирусов папилломы человека высокого и низкого онкогенного риска среди девушек-подростков Московской области. Эпидемиология и вакцинопрофилактика. 2011; 6.
15. Hwang LY, Ma Y, Shiboski SC et al. Active squamous metaplasia of the cervical epithelium is associated with subsequent acquisition of human papillomavirus 16 infection among healthy young women. J Infect Dis 2012; 206 (4): 504–11.
16. Струков А.И., Серов В.В. Патологическая анатомия. М.: Медицина, 1995.
17. Hanau CA, Begley N, Bibbo M. Cervical endometriosis: a potential pitfall in the evaluation of glandular cells in cervical smears. Diagn Cytopathol 1997; 16: 274–80.
18. Lundeen SJ, Horwitz CA, Larson CJ, Stanley MW. Abnormal cervicovaginal smears due to endometriosis: A continuing problem. Diagn Cytopathology 2002; 26: 35–40.
19. Symonds DA, Reed TP, Didolkar SM, Graham RR. AGUS in cervical endometriosis. J Reprod Med 1997; 42: 39–43.
20. McDonnell JM, Emens JM, Jordan JA. The congenital cervicovaginal transformation zone in sexually active young women. Br J Obstet Gynaecol 1984; 91 (6): 580–4.
21. Фириченко С.В., Манухин И.Б., Минкина Г.Н., Фадеева Е.А. Расширенная биопсия шейки матки во время беременности: преимущества и безопасность. Проблемы репродукции. 2012; 1: 79–84.
22. Nohr B, Tabor A et al. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery. Acta Obstet Gynecol Scand 2007; 86 (5): 596–603.
23. Arbyn M, Kyrgiou M. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008; 337: a1284.
24. Acharya G, Kjeldberg I et al. Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia. Arch Gynecol Obstet 2005; 272 (2): 109–12.
25. Althuisius SM, Schornagel IJ et al. Loop electrosurgical excision procedure of the cervix and time of delivery in subsequent pregnancy. 2001; 72 (1): 31–4.
26. Sadler L, Saftlas A, Wang W et al. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004; 291: 2100–6.
27. Castanon A, Brocklehurst P, Evans H et al. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study. BMJ 2012; 34–5.
28. Фириченко С.В., Манухин И.Б., Минкина Г.Н. и др. Эксцизионное лечение цервикальной интраэпителиальной неоплазии и риск преждевременных родов. Проблемы репродукции. 2012; 4: 95–9.
29. Mitchell MF, Schottenfeld D, Tortolero-Luna G et al. Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998; 91: 626–31.
30. Gentry DJ et al. The effects of loop excision of the transformation zone on cervical length: implications for pregnancy. Am J Obstet Gynecol 2000; 182 (3): 516–20.
Авторы
С.В.Фириченко, И.Б.Манухин, Г.Н.Минкина, Л.Б.Студеная, В.В. Казенашев
Кафедра акушерства и гинекологии лечебного факультета ГБОУ ВПО МГМСУ им. А.И.Евдокимова Минздрава РФ
Кафедра акушерства и гинекологии лечебного факультета ГБОУ ВПО МГМСУ им. А.И.Евдокимова Минздрава РФ
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