The study was performed on the clinical bases of the Department of Perinatology, Obstetrics and Gynecology of the Kharkiv Medical Academy of Postgraduate Education. A retrospective clinical and statistical analysis of pregnancy and childbirth histories (414 women) and a prospective clinical and laboratory study (136 women) were performed. Criteria for inclusion in the study were: singleton full-term pregnancy (gestational age from 37 weeks and more); the main presentation of the fetus; no scar on the uterus (cesarean section and / or other operations on the uterus). Women with pregnancies resulting from assisted reproductive technologies were not included in the study. The distribution of women included in the study was carried out according to the task: I (main) group - 129 women who gave birth by cesarean section (CS), including Ia subgroup - 65 women in whom childbirth was complicated by labor dystocia (LD) ; Ib subgroup - women who gave birth by CS, according to other indications; Group II (comparison) - 421 women who gave birth naturally, including subgroup IIa - 52 women who gave birth naturally, in whom childbirth was complicated by LD; Subgroup IIb - 349 women who gave birth naturally, in the absence of LD.
All mothers on admission to the hospital underwent standard laboratory (clinical and biochemical) studies in accordance with the scheme of mandatory studies. Additionally, the concentration of lactic acid (lactate) in amniotic fluid and venous blood plasma was studied in 50 women with LD (including in 17 cases of vaginal delivery and in 33 - CS), and in 86 women without LD (including 69 women with vaginal births and 17 women The study was performed photometrically using a set of reagents Liquick Cor-LACTATE (manufactured by Cormay, Poland).
The structure of births in 2,071 women in labor was analyzed separately, including 726 (35.1%) by CS. The general structure of childbirth was dominated by women with full-term singleton pregnancy, main presentation of the fetus, spontaneous labor of the first (1st group) or repeated (3rd group) childbirth (in the amount of 57.1%). In group 1, 12.5%, in group 3, 2.6% of women gave birth by caesarean section, mostly due to emergency indications. Women in group 2 accounted for 18.5% (first birth with full-term singleton pregnancy and main presentation of the fetus with planned induction of labor - group 2a) or planned cesarean section - group 2b) (programmed birth). In women, group 2a of CS was performed in 20.8% of cases, which is most often due to unsuccessful induction of labor.
During the analysis of the structure of indications for CS it was found that in 59.4% of cases CS was performed with the planned CS (group 2) and in the presence of a scar on the uterus (26.7%). A significant percentage were women with pelvic or transverse fetal presentation (6th, 7th and 9th groups), multiple pregnancies (8th group) and premature birth (10th group), which totaled 17, 6%. That is, in 77% of cases, childbirth took place according to generally accepted indications.
In most cases, CS in women of groups 1, 2, 3 and 4 occurred due to complications of childbirth or due to new data on the risk of complications during childbirth. Among these women, a fairly common indication for emergency CS is primary LD (in groups 1 and 3) or LD after unsuccessful induction of labor. This contingent of pregnant women and parturients requires special attention because it is a reserve for reducing the incidence of CS, on the other - to determine the optimal time of CS.
In the main part of the study it is established. that one indication for CS was in 71 (55.0%) women, including LD - 38 (29.5%); fetal distress - 17 (13.2%); premature rupture of amniotic membranes (PRAM) - 3 (2.3%); placental abruption - 7 (5.4%) and cervical anomalies - 6 (4.7%). In 55 (45.0%) there were two or more indications for CS: LD and fetal distress - 7 (5.4%); LD on the background of fetal-pelvic disproportions (FPD) - 5 (3.9%). PRAM most often led to LD - 12 (9.3%); in 4 (3.1%) cases to the development of fetal distress and 3 (2.3%) to the development of LD and fetal distress. In addition, in 27 (20.9%) cases, the cause of CS was macrosomia and comorbidities of the mother in various combinations. LD in isolation or in combination with other indications for CS was observed in 65 (50.4%) women in labor.
According to the results of frequency analysis of clinical and anamnestic indicators, it was found that women who gave birth by CS were significantly more likely to have late reproductive age (15.5% vs. 8.6%), first pregnancy (
