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Roman Shmakov: “Our technologies show impressive results”

MONIAG is the largest scientific and medical institution in Russia, on the basis of which state programs are implemented to preserve the health of women, mothers and children. Roman Shmakov, Director of the Institute, Chief freelance specialist in Obstetrics at the Ministry of Health of the Russian Federation, Professor of the Russian Academy of Sciences, tells our readers today about the specifics of introducing the latest technologies in regional centers, routing of severe patients, telemedicine consultations and medical tourism.

Roman Georgievich, you were lucky enough to work in the same team with many “stars” of Russian surgery. How has gynecology changed over the years?

Today, the MONIAG is the largest scientific clinical base in Russia, where the most ambitious projects are implemented and the most urgent tasks in the field of obstetrics are solved. But when we started dealing with the problem of “Cancer and pregnancy” 20 years ago, there was absolutely nothing in terms of logistics. And if in 2002 we conducted only 5 pregnant patients with active malignant diseases, then in 2021 this figure increased to 92! We have developed and implemented in 35 regions of Russia a method of operations for placenta accreta, a severe life–threatening pathology. Through interaction with pediatric surgeons and cardiologists, fetal medicine is developing, which includes intrauterine surgery and therapy. For example, nonimmune fetal dropsy in a child has always meant a 100% fatal outcome. With this pathology, fluid accumulates in various cavities of the body, ascites, hydrothorax and hydropericardium occur. We have developed diagnostic and treatment algorithms, on the basis of which we managed to achieve a 50% survival rate in such children. These are very good results, similar to the world ones. One of the main areas of fetal surgery in our center is myelomeningocele. This is a condition when the fetus has a defect in the closure of the spinal column. If surgical treatment is not carried out in time, then the child will have severe neurological disorders, as a result of which he may become deeply disabled. We have already performed 30 such operations, studied with colleagues from Switzerland, the USA and Brazil.

How successfully is it possible to solve the problem of the compatibility of oncology and pregnancy today?

– I have always believed that cancer is not a reason to have an abortion. The success in this area is due to the long-term systematic work of our multidisciplinary team, which includes obstetricians and gynecologists, anesthesiologists, intensive care specialists, neonatologists, oncologists, chemotherapists and representatives of many other specialties. Thanks to this comprehensive approach to the problem, we were able to develop an algorithm for the management of pregnant women with an oncological diagnosis. On the other hand, pregnancy does not affect the course of cancer, and children are born healthy.

We have been working with the so-called “large obstetric syndromes” for a long time, successfully treating patients with severe preeclampsia, with fetal growth retardation. Or another pathology – a severe lesion of the spinal cord, diagnosed in utero. If such children survive, they become deeply disabled with mental development problems. Only special intrauterine operations can radically change the situation, which prevent the development of hydrocephalus and thereby prevent the pathological process. We have already operated on 30 patients with such a malformation at a period of 24-26 weeks. Today, these children are already walking on their own feet. We keep an eye on them, constantly examine them and, of course, rejoice with their parents!

What is being done in the country to prevent maternal mortality?

– Obstetric bleeding is one of the main causes of maternal mortality. And this is a very serious problem, which is often associated with placenta accreta, which entails a high risk of mortality. The more scars and cesarean sections a woman has, the more likely it is that the placenta will grow.
According to American statistics, 20 out of 8,000 women with placenta accreta die. In five years, more than 400 pregnant patients with placenta accreta have already passed through the hands of our specialists. And I can note without false modesty the good results that we have managed to achieve. Moreover, we perform organ-preserving operations, even the uterus is not removed when the placenta grows. We conducted a large all-Russian study on placenta accretion, and based on it, we identified the advantages and disadvantages of one or another method.

How actively are the technologies developed at MONIAG being implemented in the Russian regions?

– On the basis of the MONIAG, the latest scientific directions in the field of obstetrics and gynecology are being developed in order to then introduce new treatment methods into clinical practice. Some technologies are quite difficult to implement in other perinatal centers, but such work is certainly underway. Colleagues often come to us: they watch, study, communicate… The primary task of the MONIAG is precisely to be at the forefront of scientific and practical achievements. But I would like to note that there are many cities in Russia where excellent scientific schools operate on the basis of centers equipped with the latest medical technology. These are St. Petersburg, Yekaterinburg, Novosibirsk, Kazan…

It is very important to pay maximum attention to young talented specialists, including from the regions. I urge my colleagues, who are at the beginning of their professional career, to tirelessly raise their level of education and curiosity, to read a lot, including in foreign languages!

MONIAG participates in the medical tourism program for foreign citizens. Why do foreigners choose Russia and what kind of problems do they most often come to you for treatment?

– Nowadays, medicine in Russia has developed so well that the number of patients wishing to be treated in Russia is growing. The prerogative of our institute has been and remains the provision of high-quality medical care and protection of the reproductive health of the female population. In our activities, we use advanced high-tech equipment and high-quality consumables. The professionalism of our staff and their attentiveness to patients are widely known. Patient safety is above all for us! The Institute is the only institution in Russia that concentrates pregnant women with diseases of the bronchopulmonary system, the only one using the technology of two-level epidural analgesia for delivery of the most severe patients with bronchial asthma, obstructive bronchitis and chronic pneumonia. And also, the delivery of high-risk patients using blood-saving and high-tech organ-preserving techniques. The geographical location of the Institute ensures optimal accessibility of the institution (in the center of Moscow).

What is the dynamics of the growth in the number of foreign patients?

– Russia is becoming more and more popular in the world as a country where health is saved. The number of foreigners who come to us for treatment is increasing. They are attracted by the price-quality ratio, as well as the advanced achievements of domestic medicine.

Is there a specific service for patients from Muslim countries (and if so, how is it taken into account in your research institute)?

– Medicine has always been associated with religion. Obstetricians and gynecologists are familiar with the intricacies of the traditions of many nations, and we always act in the best interests of the patient. If a woman wants to be treated by another woman, we will definitely meet this wish. A person’s life, his happiness and well—being, confidence in the future for himself and his family is the main value for each of our employees. We apply the best achievements of international medical practice, our employees regularly improve their skills in the leading centers of the world. Our main priority in patient care is safety and the highest quality of services provided.