Object: pelvic injuries in women during labor. Aim: improvement of treatment results in patients with pelvic injuries resulting from labor on the basis of study of risk factors, determination of prognostic indices, development of early detection methods, application of new methods and devices. Methods: clinical, laboratory, x-ray, morphometric, immunologic, microbiological, NMRI tomography, ultrasonography, densitometry, biomechanical, static methods. Main risk factors of development of pelvic injuries in women during labor (based on the Wilcocson-Mann-Whitney statistics and analysis of its particulars) have been determined, Among them are disbalance of hormonal regulation of reproductive function, chronic urogenital infections, systemic endocrinopathy, degenerative-dystrophic diseases and pelvic injuries, anatomic features of the pelvis and a large fetus. It was established that pregnant women with relapsing urethrovesical infection (urethritis, cystitis), accompanied by hyperrelaxation of pubic symphysis before gestation is over, as well as patients with pelvic injuries during labor polymicrobial polyresistant variants of the biotope caused by biologically active products of microbial origin prevail in microbiocenosis. It influences structural-functional condition of the pubic symphysis. Results of osteal densitometry reveal that women with a tendency for hyperrelaxation of pelvic attachments are prone to decrease of bone mineral density and women with degenerative-dystrophic spinal diseases and hypoestrogenic (hyperandrogenic) conditions, on the contrary, are prone to relatively high bone mineral density. Informativity of ultrasound symphysiometry for monitoring the condition of the pubic symphysis during pregnancy has been proved. Physiological, border and pathological parameters of the pubic interspace size, which allow to obtain objective diagnostic information and to discover pelvic injuries in due time in the maternity hospital have been determined. Biomechanically supported working classification of pelvic injuries during labor has been developed. This classification is based on clinical, sonographic, X-ray and MR- tomographic criteria for pelvic joints and attachments injuries. On the basis of clinical-biomechanical research high efficiency of the application of the developed method and the device for treatment of fresh and old pelvic injuries in women during labor has been proved as compared to traditional methods. Groups with risk of developing pelvic injuries during labor, whose LS condition of during pregnancy and labor must be monitored, have been determined. It allows to to reveal injury of attachments in conditions of maternity house even in presence of suppressed clinical symptoms and signs. Ultrasonographic diagnostic parameters have been determined, which reflect normal LS condition (without pregnancy, during physiological gestation, during labor and in puerperal period), as well as criteria of pelvic vulnerability in patients from risk groups. Early detection procedure for pelvic injuries during labor with use of dynamic ultrasound symphysiometry and MRI tomography has been developed. Biomechanically based working classification of pelvic injuries during labor allows to differentiate treatment methods depending on pelvis width in LS, which reflects the condition of attachments of sacroiliac joints and degree of pelvis stability preservation. Pelvic pillow splint has been developed for intrahospital transportation of patients and instrumental diagnostics of possible injuries of pelvic attachments (Patent of Ukraine No 71865 A). Application of the developed method and device for treatment of fresh and old pelvic injuries during labor allows mobilizing the patient providing proper fixation of the pelvis with the help of high-technology thermoplastic orthesis (Patent of Ukraine No 71866 A). Research results are used in Kharkiv maternity houses No1, No5, in the City Regional Hospital, City Emergency Hospital named after prof. A.I. Mishchaninov, Zolochivska Central District Hospital, Valkivska Central District Hospital. Materials of the present work have been included into the educational process of the department of traumatology, vertebrology, sports medicine and physical culture of Kharkiv Medical Academy of Postgraduate Studies at the study of the corresponding division of traumatology and orthopedics. Traumatology and orthopedy.
