Vakaliuk L. Clinical and pathogenic substantiation of rational management of pregnancy and childbirth in women with a scar on the uterus.

Thesis awarded the development of scientific bases of forecasting, rational clinical management, selection of optimal methods of delivery and the cesarean section in women with a scar on the uterus. This is a problem that is directly related to the issues of reproductive health, maternal and perinatal morbidity and mortality. The effect of infectious somatic and obstetric pathology, parity, obstetric clinical and intraoperative situation on the formation of morph-functional usefulness of the uterus. Based on the identified risk factors identified informative clinical and instrumental signs, diagnostic and prognostic criteria to predict the formation of a full histerotomy scar. Based on morphological analysis highlighted the contours of vascularization of the uterus, especially regeneration myometrial smooth muscle cells depending on the morpho-functional usefulness histeroraffia areas and their relationship with the components microcirculatory hemodynamics channel in different parts of scarring by pathologic structure are three types of scarring in the uterus - a full, relatively complete and defective. Based on the comparison of data from clinical, laboratory, ultrasound and morphological studies developed tactics and algorithms for clinical management of pregnancy and birth in women with a scar on the uterus, reasonably specific surgical technique of repeated cesarean delivery and noninvasive intraoperative removal of the fetus from the uterus. It is shown that the proposed clinical measures lead to lower maternal and perinatal morbidity and mortality, significantly reduce the number of intra-and postoperative complications and puerperal diseases in mothers.