Obstetrics and gynecology in the USSR

Article Abstract:

Two physicians, one who obtained a doctorate in the USSR (United Soviet Socialist Republic) and was a member of the faculty of the Moscow Medical School and one who was a visiting physician at the same school, share their impressions of obstetrics and gynecology as it is practiced in the Soviet Union. Medical education, research, health care for women, and obstetric care are discussed. The USSR has 82 medical schools and a ratio of physicians to inhabitants that is the highest in the world (357 physicians per 100,000 population). Most physicians in hospitals and outpatient clinics are women, while men tend to hold administrative and academic positions. Medical school admission is easier for children of factory workers, collective farmers, and certain Party members. The curriculum takes six years to complete, with two years devoted to basic sciences and four to clinical sciences. Research results are published in Russian, with publication in international journals only after permissions from the censor and the All-Union Copyright Agency have been granted. Thus, a considerable time elapses before Soviet research reaches the rest of the world; similarly, medical developments in other countries are not easily accessible to Soviet physicians. Abortion is the leading method of contraception in the USSR, although motherhood is glorified and efforts to increase the population are constantly being made. Official reports regarding the availability and quality of child-care are exaggerated; most facilities are overcrowded. The Soviet Union ranks 50th in the world in infant mortality (25.4 deaths per 1,000 live births). In general, modern obstetrical technology is not used; for instance, ultrasound equipment is rarely available. Midwives provide much of the prenatal care, and physicians are not routinely involved. A very small proportion of births are accomplished by cesarean section (less than 8 percent), due, in part, to the fact that physicians can not be held legally responsible for the outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Soviet Union, Gynecology, Obstetrics

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Congenital nephrosis as a cause of elevated alpha-fetoprotein

Article Abstract:

Elevations in maternal serum alpha-fetoprotein (MSAFP, a protein produced by the fetus and detectable in the mother's blood) indicate a variety of fetal malformations, including congenital nephrosis (degenerative changes in the kidneys), a disorder with a poor prognosis. Results are presented from a screening program to determine MSAFP levels and associated abnormalities in 95,135 pregnant patients. Four percent (3,779) of the women had elevated levels of MSAFP; 82 elevations were at least 10 times the median value (MOM, multiples of the median). Subsequent evaluation with ultrasound could not determine the reasons for MSAFP elevations in almost half the larger group; however, abnormalities were detected on ultrasound for all but 15 of the 82 cases with MSAFP over 10 MOM. Two of these cases, which had normal ultrasound results, are described in detail. One set of parents continued the pregnancy to term; the other chose termination. Both infant and fetus had congenital nephrosis. In another case of MSAFP more than 10 MOM, the infant was normal; the alpha-fetoprotein (AFP) level in amniotic fluid (in which the fetus floats) was lower than that of the two cases with congenital nephrosis. The incidence of nephrosis was 1 in 47,567 births. The condition has a higher incidence in Finland; a brief discussion of its epidemiology is presented. Patients with very high MSAFP levels should be told that there is a possibility of congenital nephrosis. In the event of pregnancy termination, special techniques are needed to make a definitive fetal diagnosis, since the kidneys appear normal when standard methods are used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Abnormalities, Diagnosis, Measurement, Demographic aspects, Birth defects, Kidneys, Kidney, Prenatal diagnosis, Alpha fetoproteins, Nephrotic syndrome

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