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Актуальность проблемы аномальных маточных кровотечений у молодых женщин и ее комплексное решение в свете российских рекомендаций 2021
Чернуха Г.Е. Актуальность проблемы аномальных маточных кровотечений у молодых женщин и ее комплексное решение в свете российских рекомендаций 2021. Гинекология. 2022;24(3):198–205.
DOI: 10.26442/20795696.2022.3.201683
DOI: 10.26442/20795696.2022.3.201683
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Chernukha GE. Relevance of abnormal uterine bleeding issue in young women and its comprehensive solution considering 2021 Russian Guidelines. Gynecology. 2022;24(3):198–205. DOI: 10.26442/20795696.2022.3.201683
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Аннотация
Аномальное маточное кровотечение – общий термин для описания нарушений менструального цикла, характеризующихся избыточной частотой, продолжительностью и/или объемом кровопотери у небеременных женщин. До 1/3 женщин испытывают это состояние в течение жизни. Обильные менструальные кровотечения, в основе которых нет структурной патологии, могут стать серьезной проблемой для многих молодых женщин, поскольку они оказывают глубокий негативный эффект на многие аспекты их жизни и повышают риск развития железодефицитной анемии. Однако до 1/2 таких женщин рассматривают объем менструальной кровопотери как нормальный, а врачи не задают необходимые вопросы во время консультирования. Российские клинические рекомендации «Аномальные маточные кровотечения» помогут врачам в диагностике и выборе лечения для женщин, страдающих от обильного менструального кровотечения. Гормональные методы лечения включают комбинированный оральный контрацептив эстрадиола валерат/диеногест и внутриматочную систему с левоноргестрелом.
Ключевые слова: аномальное маточное кровотечение, обильное менструальное кровотечение, качество жизни, менструальная кровопотеря, ферритин, железодефицитная анемия, комбинированный оральный контрацептив эстрадиола валерат/диеногест, внутриматочная система с левоноргестрелом
Ключевые слова: аномальное маточное кровотечение, обильное менструальное кровотечение, качество жизни, менструальная кровопотеря, ферритин, железодефицитная анемия, комбинированный оральный контрацептив эстрадиола валерат/диеногест, внутриматочная система с левоноргестрелом
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Abnormal uterine bleeding is a common problem in gynecology. It is a general term to describe menstrual disorders, including frequency, regularity, duration, and bleeding volume in non-pregnant women. Up to 1/3 of women experience this condition during their lifetime. Heavy menstrual bleeding not related to structural abnormality can be a serious health problem for many young women. It has a profound adverse impact on many aspects of their lives and increases the risk of iron deficiency anemia. However, up to half of these women consider the volume of menstrual blood loss normal, and physicians do not ask the relevant questions during counseling. The Russian Clinical Guidelines "Abnormal Uterine Bleeding" provide physicians guide to the assessment, management, and choice of treatment for women with heavy menstrual bleeding.
Keywords: abnormal uterine bleeding, heavy menstrual bleeding, quality of life, menstrual blood loss, ferritin, iron deficiency anemia, levonorgestrel intrauterine system, combined oral contraceptive estradiol valerate/dienogest
Полный текст
Список литературы
1. Munro MG, Critchley HOD, Frasere IS; FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril. 2011;95(7):2204-8. DOI:10.1016/j.fertnstert.2011.03.079
2. Fraser IS, Mansour D, Breymann C, et al. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynecol Obstet. 2015;128(3):196-200. DOI:10.1016/j.ijgo.2014.09.027
3. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline (NG88). Available at: https://www.nice.org.uk/guidance/NG88/ Accessed: 29.04.2022.
4. Bitzer J, Serrani M, Lahav A. Women’s attitudes towards heavy menstrual bleeding, and their impact on quality of life. Open Access J Contracept. 2013:4:21-8. DOI:10.2147/OAJC.S38993
5. da Silva Filho AL, Caetano C, Lahav A, et al. The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey. Eur J Contracept Reprod Health Care. 2021;26(5):390-8. DOI:10.1080/13625187.2021.1925881
6. Mansour D, Hofmann A, Gemzell-Danielsson K. A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding. Adv Ther. 2021;38(1):201-25. DOI:10.1007/s12325-020-01564-y
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11. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408. DOI:10.1002/ijgo.12666
12. Munro MG. Abnormal uterine bleeding: A well-travelled path to iron deficiency and anemia. Int J Gynecol Obstet. 2020;150:275-77. DOI:10.1002/ijgo.13180
13. Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 2017;40:55-67. DOI:10.1016/j.bpobgyn.2016.09.007
14. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-16. DOI:10.1016/S0140-6736(15)60865-0
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DOI:10.18565/aig.2019.6.140-145
18. Moos T, Skjorringe T, Thomsen LL. Iron deficiency and iron treatment in the fetal developing brain – a pilot study introducing an experimental rat model. Reprod Health. 2018;15(Suppl. 1):93. DOI:10.1186/s12978-018-0537-0
19. Kaveh M, Sadegi K, Salarzaei M, Parooei F. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the endometrial polyps in women with abnormal uterine bleeding: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne. 2020;15(3):403-15.
DOI:10.5114/wiitm.2020.93791
20. Lunardi Rocha AL, Cristina França Ferreira M, Mara Lamaita R, et al. Heavy menstrual bleeding: a global survey of health care practitioners’ perceptions. Eur J Contracept Reprod Health Care. 2018;23(4):288-94. DOI:10.1080/13625187.2018.1483018
21. Fraser IS, Parke S, Mellinger U, et al. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care. 2011;16(4):258-69. DOI:10.3109/13625187.2011.591456
22. Yu Q, Zhou Y, Suturina L, et al Efficacy and Safety of Estradiol Valerate/Dienogest for the Management of Heavy Menstrual Bleeding:
A Multicenter, Double-Blind, Randomized, Placebo-Controlled, Phase III Clinical Trial. J Womens Health (Larchmt). 2018;27(10):1225-32. DOI:10.1089/jwh.2017.6522
23. Доброхотова Ю.Э., Ибрагимова Д.М., Гришин И.И. Меноррагия: есть ли пути решения? Медицинский совет. 2016;12:12-3 [Dobrokhotova YE, Ibragimova DM, Grishin II. Menorrhagia: are there any solutions? Meditsinskii sovet. 2016;12:12-3 (in Russian)]. DOI:10.21518/2079-701X-2016-12-12-13
24. Hickey M, Agarwal S. Unscheduled bleeding in combined oral contraceptive users: focus on extended-cycle and continuous-use regimens. J Fam Plann Reprod Health Care. 2009;35(4):245-8. DOI:10.1783/147118909789587411
25. Dinger J, Möhner S, Heinemann K. Combined oral contraceptives containing dienogest and estradiol valerate may carry a lower risk of venous and arterial thromboembolism compared to conventional preparations: Results from the extended INAS-SCORE study. Front Womens Health. 2020;5:1-8. DOI:10.15761/FWH.1000178
26. Chen BA, Eisenberg DL, Schreiber CA, et al. Bleeding changes after levonorgestrel 52-mg intrauterine system insertion for contraception in women with self-reported heavy menstrual bleeding. Am J Obstet Gynecol. 2020;222(4S):S888.e1-6. DOI:10.1016/j.ajog.2019.11.1288
27. Gupta J, Kai J, Middleton L, et al. Levonorgestrel intrauterine system versus medical therapy for menorrhagia. N Engl J Med. 2013;368:128-37. DOI:10.1056/NEJMoa1204724
28. Lethaby A, Hussain M, Rishworth JR, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015;4:CD002126. DOI:10.1002/14651858.CD002126.pub3
29. Beelen P, van den Brink MJ, Herman MC, et al. Levonorgestrel-releasing intrauterine system versus endometrial ablation for heavy menstrual bleeding. Am J Obstet Gynecol. 2021;224(2):187.e1-10. DOI:10.1016/j.ajog.2020.08.016
30. van den Brink MJ, Beelen P, Herman MC, et al. The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis. BJOG. 2021;128(12):2003-11. DOI:10.1111/1471-0528.16836
31. Драпкина О.М., Мартынов А.И., Байда А.П., и др. Резолюция экспертного совета «Актуальные вопросы железодефицита в Российской Федерации». Кардиоваскулярная терапия и профилактика. 2020;19(5):2700 [Drapkina OM, Martynov AI, Baida AP. Resolution of the expert council “Relevant issues of iron deficiency in the Russian Federation”. Cardiovascular Therapy and Prevention. 2020;19(5):2700 (in Russian)]. DOI:10.15829/1728-8800-2020-2700
32. Friedman AJ, Shander A, Martin SR, et al. Iron deficiency anemia in women: a practical guide to detection, diagnosis, and treatment. Obstet Gynecol Surv. 2015;70:342-53. DOI:10.1097/OGX.0000000000000172
33. DeLoughery TG. Iron deficiency anemia. Med Clin North Am. 2017;101(2):319-32. DOI:10.1016/j.mcna.2016.09.004
2. Fraser IS, Mansour D, Breymann C, et al. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynecol Obstet. 2015;128(3):196-200. DOI:10.1016/j.ijgo.2014.09.027
3. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline (NG88). Available at: https://www.nice.org.uk/guidance/NG88/ Accessed: 29.04.2022.
4. Bitzer J, Serrani M, Lahav A. Women’s attitudes towards heavy menstrual bleeding, and their impact on quality of life. Open Access J Contracept. 2013:4:21-8. DOI:10.2147/OAJC.S38993
5. da Silva Filho AL, Caetano C, Lahav A, et al. The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey. Eur J Contracept Reprod Health Care. 2021;26(5):390-8. DOI:10.1080/13625187.2021.1925881
6. Mansour D, Hofmann A, Gemzell-Danielsson K. A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding. Adv Ther. 2021;38(1):201-25. DOI:10.1007/s12325-020-01564-y
7. Российское общество акушеров-гинекологов. Клинические рекомендации. Аномальные маточные кровотечения. 2021. Режим доступа: https://minzdrav.samregion.ru/wp-content/uploads/sites/28/2021/07/kr645.pdf/ Ссылка активна на 29.04.2022 [Rossiiskoe obshchestvo akusherov-ginekologov. Klinicheskie rekomendatsii. Anomal'nye matochnye krovotecheniia. 2021. Available at: https://minzdrav.samregion.ru/wp-content/uploads/sites/28/2021/07/kr645.pdf/ Accessed: 29.04.2022 (in Russian)].
8. Singh S, Best C, Dunn S, et al. No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can. 2018;40(5):e391-415. DOI:10.1016/j.jogc.2018.03.007
9. Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017;40:3-22. DOI:10.1016/j.bpobgyn.2016.09.011
10. Committee on Practice Bulletins–Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013;122(1):176-85. DOI:10.1097/01.AOG.0000431815.52679.bb
11. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408. DOI:10.1002/ijgo.12666
12. Munro MG. Abnormal uterine bleeding: A well-travelled path to iron deficiency and anemia. Int J Gynecol Obstet. 2020;150:275-77. DOI:10.1002/ijgo.13180
13. Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 2017;40:55-67. DOI:10.1016/j.bpobgyn.2016.09.007
14. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-16. DOI:10.1016/S0140-6736(15)60865-0
15. Mirza FG, Abdul-Kadir R, Breymann C, et al. Impact and management of iron deficiency and iron deficiency anemia in women’s health. Exp Rev Hematol. 2018;11(9):727-36. DOI:10.1080/17474086.2018.1502081
16. Ших Е.В., Бриль Ю.А. Железодефицит: катастрофа для нейрогенеза. StatusPraesens: гинекология, акушерство, бесплодный брак. 2018;5(51):82-8 [Shikh EV, Bril' IuA. Zhelezodefitsit: katastrofa dlia neirogeneza. StatusPraesens: ginekologiia, akusherstvo, besplodnyi brak. 2018;5(51):82-8 (in Russian)].
17. Виноградова М.А. Анемия у женщин репродуктивного возраста: диагностика и коррекция железодефицита. Акушерство и гинекология. 2019;6:140-5 [Vinogradova MA. Anemiia u zhenshchin reproduktivnogo vozrasta: diagnostika i korrektsiia zhelezodefitsita. Akusherstvo i ginekologiia. 2019;6:140-5 (in Russian)].
DOI:10.18565/aig.2019.6.140-145
18. Moos T, Skjorringe T, Thomsen LL. Iron deficiency and iron treatment in the fetal developing brain – a pilot study introducing an experimental rat model. Reprod Health. 2018;15(Suppl. 1):93. DOI:10.1186/s12978-018-0537-0
19. Kaveh M, Sadegi K, Salarzaei M, Parooei F. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the endometrial polyps in women with abnormal uterine bleeding: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne. 2020;15(3):403-15.
DOI:10.5114/wiitm.2020.93791
20. Lunardi Rocha AL, Cristina França Ferreira M, Mara Lamaita R, et al. Heavy menstrual bleeding: a global survey of health care practitioners’ perceptions. Eur J Contracept Reprod Health Care. 2018;23(4):288-94. DOI:10.1080/13625187.2018.1483018
21. Fraser IS, Parke S, Mellinger U, et al. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care. 2011;16(4):258-69. DOI:10.3109/13625187.2011.591456
22. Yu Q, Zhou Y, Suturina L, et al Efficacy and Safety of Estradiol Valerate/Dienogest for the Management of Heavy Menstrual Bleeding:
A Multicenter, Double-Blind, Randomized, Placebo-Controlled, Phase III Clinical Trial. J Womens Health (Larchmt). 2018;27(10):1225-32. DOI:10.1089/jwh.2017.6522
23. Доброхотова Ю.Э., Ибрагимова Д.М., Гришин И.И. Меноррагия: есть ли пути решения? Медицинский совет. 2016;12:12-3 [Dobrokhotova YE, Ibragimova DM, Grishin II. Menorrhagia: are there any solutions? Meditsinskii sovet. 2016;12:12-3 (in Russian)]. DOI:10.21518/2079-701X-2016-12-12-13
24. Hickey M, Agarwal S. Unscheduled bleeding in combined oral contraceptive users: focus on extended-cycle and continuous-use regimens. J Fam Plann Reprod Health Care. 2009;35(4):245-8. DOI:10.1783/147118909789587411
25. Dinger J, Möhner S, Heinemann K. Combined oral contraceptives containing dienogest and estradiol valerate may carry a lower risk of venous and arterial thromboembolism compared to conventional preparations: Results from the extended INAS-SCORE study. Front Womens Health. 2020;5:1-8. DOI:10.15761/FWH.1000178
26. Chen BA, Eisenberg DL, Schreiber CA, et al. Bleeding changes after levonorgestrel 52-mg intrauterine system insertion for contraception in women with self-reported heavy menstrual bleeding. Am J Obstet Gynecol. 2020;222(4S):S888.e1-6. DOI:10.1016/j.ajog.2019.11.1288
27. Gupta J, Kai J, Middleton L, et al. Levonorgestrel intrauterine system versus medical therapy for menorrhagia. N Engl J Med. 2013;368:128-37. DOI:10.1056/NEJMoa1204724
28. Lethaby A, Hussain M, Rishworth JR, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015;4:CD002126. DOI:10.1002/14651858.CD002126.pub3
29. Beelen P, van den Brink MJ, Herman MC, et al. Levonorgestrel-releasing intrauterine system versus endometrial ablation for heavy menstrual bleeding. Am J Obstet Gynecol. 2021;224(2):187.e1-10. DOI:10.1016/j.ajog.2020.08.016
30. van den Brink MJ, Beelen P, Herman MC, et al. The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis. BJOG. 2021;128(12):2003-11. DOI:10.1111/1471-0528.16836
31. Драпкина О.М., Мартынов А.И., Байда А.П., и др. Резолюция экспертного совета «Актуальные вопросы железодефицита в Российской Федерации». Кардиоваскулярная терапия и профилактика. 2020;19(5):2700 [Drapkina OM, Martynov AI, Baida AP. Resolution of the expert council “Relevant issues of iron deficiency in the Russian Federation”. Cardiovascular Therapy and Prevention. 2020;19(5):2700 (in Russian)]. DOI:10.15829/1728-8800-2020-2700
32. Friedman AJ, Shander A, Martin SR, et al. Iron deficiency anemia in women: a practical guide to detection, diagnosis, and treatment. Obstet Gynecol Surv. 2015;70:342-53. DOI:10.1097/OGX.0000000000000172
33. DeLoughery TG. Iron deficiency anemia. Med Clin North Am. 2017;101(2):319-32. DOI:10.1016/j.mcna.2016.09.004
________________________________________________
1. Munro MG, Critchley HOD, Frasere IS; FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril. 2011;95(7):2204-8. DOI:10.1016/j.fertnstert.2011.03.079
2. Fraser IS, Mansour D, Breymann C, et al. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynecol Obstet. 2015;128(3):196-200. DOI:10.1016/j.ijgo.2014.09.027
3. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline (NG88). Available at: https://www.nice.org.uk/guidance/NG88/ Accessed: 29.04.2022.
4. Bitzer J, Serrani M, Lahav A. Women’s attitudes towards heavy menstrual bleeding, and their impact on quality of life. Open Access J Contracept. 2013:4:21-8. DOI:10.2147/OAJC.S38993
5. da Silva Filho AL, Caetano C, Lahav A, et al. The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey. Eur J Contracept Reprod Health Care. 2021;26(5):390-8. DOI:10.1080/13625187.2021.1925881
6. Mansour D, Hofmann A, Gemzell-Danielsson K. A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding. Adv Ther. 2021;38(1):201-25. DOI:10.1007/s12325-020-01564-y
7. Rossiiskoe obshchestvo akusherov-ginekologov. Klinicheskie rekomendatsii. Anomal'nye matochnye krovotecheniia. 2021. Available at: https://minzdrav.samregion.ru/wp-content/uploads/sites/28/2021/07/kr645.pdf/ Accessed: 29.04.2022 (in Russian).
8. Singh S, Best C, Dunn S, et al. No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can. 2018;40(5):e391-415. DOI:10.1016/j.jogc.2018.03.007
9. Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017;40:3-22. DOI:10.1016/j.bpobgyn.2016.09.011
10. Committee on Practice Bulletins–Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013;122(1):176-85. DOI:10.1097/01.AOG.0000431815.52679.bb
11. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408. DOI:10.1002/ijgo.12666
12. Munro MG. Abnormal uterine bleeding: A well-travelled path to iron deficiency and anemia. Int J Gynecol Obstet. 2020;150:275-77. DOI:10.1002/ijgo.13180
13. Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 2017;40:55-67. DOI:10.1016/j.bpobgyn.2016.09.007
14. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-16. DOI:10.1016/S0140-6736(15)60865-0
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Авторы
Г.Е. Чернуха*
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия
*g_chernukha@oparina4.ru
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия
*g_chernukha@oparina4.ru
________________________________________________
Galina E. Chernukha*
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*g_chernukha@oparina4.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.