The dissertation focuses on reducing frequency of intra and postoperative complications of cesarean section in pregnant women with placenta previa by developing and implementing an improved method of surgical intervention.
Placenta previa one of the most severe obstetrician complications of course of pregnancy and delivery, moreover it is the main cause of massive bleeding in obstetrics. All over the world scientists are concerned by increasing of frequency this pathology, which today is about 5% in structure of all pregnancies and it tends to increase in future (2,26,41). The reason for this is an increase in number of caesarean sections as a way of delivery. According to statistics, placenta previa more likely characterized by uterine atony, which can cause to hysterectomy as a way wo save woman`s life (2,8,11,92,106). Hysterectomy leads to woman`s disability and inability to realize reproductive function in future, which may be the cause of psycoemotional disorders in family life. According to publications, placenta previa is more often accompanied by lethal consequences due to massive bleeding (8,18,21,124) Among the complications during C-section, the first place is taken by bleeding and uterine atony (18,21). In postoperative period, complications such as anemia, endometritis, uterine subinvolution, hematomas are more common (18,21,144).
Nowadays, there are a lot of different methods and compression sutures are used during C-section in women with placenta previa, but not always it allows to achieve hemostasis. Therefore, the development of effective organ-preserving methods of surgery during C-section in women with placenta previa is relevant in obstetrics not only in Ukraine but also in the world (11,144,152). This dissertation is devoted to development and implementation in practice a new method for preventing and stopping massive bleeding in women with placenta previa, which involves compression of the lower uterine segment (COLUS).
To achieve this goal, we comprehensively and dynamically examined 152 pregnant women, which were divided into 2 groups, of which 122 pregnant women with placenta previa of the main group and 30 pregnant women of the control group with normal placental location. Depending on the management of pregnancy cases, the main group is divided into 2 subgroups, where the first subgroup of 62 pregnant women who in the first trimester of pregnancy (10-12 weeks) were diagnosed with abnormal chorionic location (placenta). This subgroup was managed in accordance with the order of the Ministry of Health of Ukraine № 205 of 24.03.2014. In turn, the second subgroup of 60 pregnant women diagnosed with abnormal chorionic position from the first trimester (10-12 weeks), which were carried out according to the tactics proposed by us, which provides outpatient monitoring up to 35 weeks of pregnancy and delivery on 36 weeks – 36 weeks + 6 days with prevention of RDS of the fetus 48 hours before C–section using the method of compression of the lower uterine segment (COLUS).
The age of pregnant women in the main group and the control group ranged from 20-42 years. According to our data, complete migration of the placenta occurred most often in 37 women (72.8 % pregnant women with localization of the placenta on the anterior wall of the uterus), while partial migration in 27 (64.3%) women with localization of the placenta on the posterior wall. Lack of migration in complete and partial previa was most often at the location of the placenta on the posterior wall of 57.2% and 87.5%, respectively.
