Sokolovska I. Individually informed choice of the method of delivery for women with breech presentation

The Thesis is devoted to a new approach to pregnancy management and childbirth in women with breech presentation individually justified by observing the tactics of such a contingent of women. To achieve the goal and objectives was carried out a retrospective analysis of 144 stories of women giving birth in the breech position, which included delivery by caesarean section or vaginal delivery, identified the advantages and disadvantages of each option. Also held biometric measurements of 288 fetuses to determine the harmonious growth and development of fetuses that are in breech presentation, as well as choice of tactics of delivery. In consequence of ultrasound and Doppler study of 114 pregnant women with breech and 30 pregnant women with cephalic in the third trimester of gestation the possibility of the birth of the fetus through the birth canal was evaluated. A conservative delivery in 114 pregnant women with breech presentation using the classic hand method, Lovset' method and the modified by author Lovset' method was held, the state of the newborn during the neonatal period, and depending on the use of obstetric aid assessed. The analysis of the course of pregnancy, childbirth and the postpartum period, newborn state, depending on the mode of delivery in breech presentation was made in this thesis. For the first time given scientific credence the technique used by Lovset during the second stage of labor, compared with its classical manual developed a modified method and proved its effectiveness. A comparative analysis of the impact of different ways of providing obstetric care during childbirth in pregnant women with CCI according to the state of infants and children during the neonatal period was made. For the first time it was proved that the condition of children born in the breech position by using Lovset' method and its modifications in the neonatal period on clinical indicators are better than the state of infants born with the use of a classical manual receive. The practical significance of the results implies the development of an individual approach to screening pregnant women with breech presentation of the fetus in the third trimester of gestation, at the stage of prenatal and obstetric hospital and tactics of delivery; reduction of the number of errors in the determination of the estimated fetal weight by using ultrasound and determination dopplerometric fetometry indicators reflecting the state of utero-placental blood flow. Developed step by step instructions and schematic representation technique for improved Lovset and its modifications, proved their clinical efficacy in the prevention of maternal and child injury, reducing perinatal pathology. It is proved that the number of complications in newborns, delivered with the use of Lovset' method (16.6 per cent) or a modification thereof (7.5per cent) was significantly smaller than in classical hand-care (72.9 per cent).