Golyanovskyy O. Prediction, prevention and treatment of massive obstetric hemorrhages.

The clinical efficacy of different methods of surgical hаemostasis of massive obstetric hemorrhages has been studied; the necessity of prediction, prevention and early treatment of this severe complication has been established. It has been found out that the etiological causes of massive obstetric hemorrhage development are impairments of one of 4 basic pathogenetic processes, referred to as "4T": uterine tonus impairment (up to 77.0% of all cases), placenta abnormality (12.0%), traumas of maternal passages (10.0%) and impairment of blood coagulation properties (coagulative hemorrhages) - 1.0%. High clinical efficacy of organ-saving methods of ligation of uterine great vessels as well as their advantages over conventional hysterectomy have been reliably proven. These advantages included: shorter time of hemorrhage arrest (23.5±3.0 and 45.0±2.0 min., respectively), shorter surgery duration (67.0±2.0 min. vs. 127.0±5.0 min.) and lesser intraoperational blood loss (317.0±25.0 vs. 755.0±30.0 ml, respectively), as well as preservation of the female reproductive organ. It has been established that the combined ligation of uterine, ovarian vessels and sacrouterine ligaments using modern suture material is the most effective, simple, and quick haemostasis method in case of uterine hypotonia and atony. When the cause of hemorrhage is a uterine tonomotor dysfunction, it is recommended to begin the stage-by-stage surgical haemostasis with this technique. The most optimal technique of organ-saving surgeries with stage-by-stage partial uterine devascularization using modern suture material (useful model patent № 45813 - "Method of organ-saving arrest of massive obstetric hemorrhage" registered in State Patent Register of Ukraine of 25.11.2009) has been developed, which clearly shows the main stages of the operative intervention. The main indications for preventive and therapeutic ligation of iliac arteries have been defined and worded. The complex approach (CA) to the problem solution of obstetric hemorrhages, including 4 consecutive stages, has been developed and first implemented. The clinical testing of the set of actions for prediction, prevention and therapy of massive obstetric hemorrhages has proven its efficacy and necessity of implementation of organ-saving methods of surgical haemostasis in obstetric institutions with both the preventive and treatment purpose and has allowed us to offer the changes to the current protocol on obstetric hemorrhages and the algorithm of actions when they occur (Order №676 of Ministry of Health of Ukraine).