Ivankova I. Improvement of methods of diagnostics and algorithm of delivery of women with pathology of placenta

The dissertation is devoted to the problem of increasing the efficiency of prevention and treatment of massive obstetric bleeding in pregnant women with pathology of the placenta and attachment of the placenta with the help of modern methods of diagnostics and improvement of the algorithm of delivery in order to reduce the maternal morbidity and mortality rate. It has been proved that in pregnant women with anomalies of location and attachment of the placenta, hyperplastic processes of the endometrium and transferred due to them scraping of the mucous membrane of the uterus in history were more often found in patients with placental growth; the transferred trophoblastic diseases influence the risk of anomaly of location and attachment of the placenta; the relationship between the depth of placental tissue invasion and parity was established. The calculation of the odds ratio confirmed the high risk of anomaly of attachment of the placenta in cases previously conducted 2 CDs and more according to the anamnesis (p<0.01); established a direct correlation between the number of CDs in the anamnesis and placental growth. the preferred presentation was full placental presentation, which clearly indicates the effect of placental presentation on the risk of true placental enlargement/extension (p<0.001). The prognostic value of different methods of diagnosis of placental pathology (ultrasound, Doppler ultrasound, MRI) for the choice of method and scope of surgical intervention is established. The sensitivity of the ultrasound method for establishing the anomaly of location and attachment of the placenta was 96.4%, specificity - 94.1%, versus 94.5% sensitivity and 90.4% specificity for MRI. The necessity of elaboration of the algorithm of delivery of pregnant women with placental pathology and complex of medical measures using modern methods of surgical hemostasis, uterotonic therapy and high-frequency argonoplasmic tissue coagulation is scientifically substantiated and the method of performing cesarean delivery is put into practice. Scientific work has allowed to increase the efficiency of prognosis and prevention of obstetric bleeding in the case of placental pathology, to preserve the reproductive organ, to reduce the index of maternal morbidity and mortality, as well as to introduce into the practical activity of obstetric institutions with surgical and pediculosis treatment with technical and medical support. pl.percreta.