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4 курс / Акушерство и гинекология / Ведение_и_родоразрешение_беременных_с_заболеваниями_сердца_Хитров

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1987.

7.Burlew B.S.Managing the Pregnant Patient with Heart Disease//Clin.Cardiol.-1990.- Vol.13,N 11.-P.757-762.

8.Cox S.M.,Leveno K.J. Pregnancy Complicated by Bacterial Endocarditis//Clin.Obstetr.Gynecol.-1989.-Vol.32,N 1.-P.48-53.

9.Kleine M.-W.Was halt der kritischen Abwagung stand?//Therapiewoche.-1991.-Bd 41,H 33.-S.2054-2060.

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