Introduction: According to the WHO, obstetric bleeding keeps a leading position among the top three causes of maternal mortality. The incidence of abnormal blood loss (BL) varies widely from 1.5% to 22%, and the incidence of acute blood loss reaches up to 1,7%, with the variation from 0% to 4%. Every year, this complication causes death in 128 women that amounts to 1.7% per 1,000 deliveries The aim of this study is a comparative analysis of intraoperative blood loss during the classical cesarean section described by M. Stark and modified cesarean section was performed. Materials and metods: The study has been conducted on the basis of the Obstetrics department of the Kherson regional clinical hospital. Patients were selected according to the type of surgery (the classical technique described by M. Stark or the modified method) for the period from 2015 to 2018. The formation of the clinical groups was performed in accordance with the retrospective data retrieved from the labor and delivery records of 205 patients, who delivered via cesarean section. The comparative estimation of intraoperative blood loss volumes was carried out using a direct (gravimetric) method. Results: The proposed modification of abdominal delivery is based on the rational teamwork of a surgeon and an assistant, with the modernization of the surgical stages allowed halving the surgery duration as compared to the classical cesarean section technique introduced by M. Stark. Аnd the improved surgical technique of abdominal delivery contributes to the reduction in the volume of intraoperative blood loss by 200 ml (p < 0,001). Conclusions: Modified cesarean section allows avoiding massive obstetric hemorrhage, thereby creating an additional reserve for improving the safety of the operative delivery in general.
Introduction. The hormonal system “vitamin D/vitamin D receptors” (VD/VDR) is involved in the regulation of numerous physiological processes. VD lack or deficiency is associated with a number of different diseases, including pregnancy complications.Purpose of the study: to determine VD status and its effect on the course of the gestational process in women from the southern region of Ukraine.Materials and methods. 459 women were examined, 318 (69.3%) of them were the main group and 141 (30.7%) were the comparison group.In addition to standard general clinical examinations, ELISA on a COBAS Integra 400 Plus analyzer (Roche Diagnostics, Switzerland) the VD level was determined in the blood.Results and discussion. 49.9% of the pregnant women in the main group had insufficient VD level (25.45 ± 4.63 ng/ml), in 19.4% it corresponded to a deficit (15.28 ± 4.78 ng/ml). VD concentration in the comparison group was 43.38 ± 9.67 ng/ml (p <0.01). Significantly more frequent pregnancy complications in the main group were threatening abortion (45.6% VS 9.9%; F = 0.00001; p <0.01), preeclampsia (13.5% VS 2.8%; F = 0.0093; p <0, 05), placental dysfunction (32% VS 7%; F = 0.00001; p <0.01), vaginal dysbiosis (64.4% VS 18.4%; F = 0.00001; p <0.01), pregnant anemia (43.7% VS 20.6%; F = 0.0008; p <0.01) and signs of inflammation of the amniotic membranes (38.3% VS 13.4%). Syndrome of intrauterine growth retardation diagnosed in 9% women in the main group; in the comparison group none case was noted.Conclusion. 70% of pregnant women in Odesa region have a lack or deficiency of VD. Pregnancy course is characterized by a significantly greater frequency of preeclampsia (4.8 times more often), placental dysfunction (4.5 times), threat of miscarriage (4.6 times more often), intrauterine infection (2.8 times more often), gestational anemia (2.5 times more). It seems promising to conduct further research on the possibility of preventing complications of the gestational process by correcting VD status.
Clinical manifestations in the abdominal cavity of a woman in labor, discovered during an urgent cesarean section at 41 weeks of gestation 2 months after an acute form of COVID-19, are described. The materials of medical documentation were analyzed and the features of the course of pregnancy by trimester, urgent cesarean section, postoperative period, laboratory parameters, ultrasound data, cardiotocography, fetal condition at birth and three days later were determined.Presentation of case. 33-year-old pregnant woman (pregnant for the first time) had COVID-19 at 26 weeks of gestation. At a cesarean section for urgent indications at 41 weeks of gestation during the revision of the abdominal cavity was found that the visceral peritoneum of the uterus along the anterior and posterior surfaces, fallopian tubes, wide and round uterus ligaments, ovaries and parietal peritoneum of the pelvis, areas of the serous intestinal layer were with expressive signs of edema covered with vesicular rash, in places in the conglomerate, which were bleeding. There was no abdominal effusion.The child was born with 7–8 points Apgar score and had a negative PCR result for COVID-19. Placenta measuring 25 x 21 x 5.0 x 0.5 cm with multiple petrification, single red heart attacks. The shells are distinctly yellow-gray-green in color. The umbilical cord is 70 cm long and usual color. Amniotic fluid is clear. The early and late postoperative periods and the postpartum period proceeded without complications. At once the disorders in the blood coagulation system, immune system, positive COVID-19 IgG and IgM were identified in mother. Videin, Magniсum-antistress, preparations of acetylsalicylic acid and for the comprehensive support of the physiological state of the intestine were used in the complex treatment of the postpartum period.Conclusion. COVID-19 disease is pathology with many unknowns. Therefore, each clinical observation is important for studying of its course. Post-COVID syndrome and long-COVID syndrome have individual characteristics. Collective experience will contribute to the definition of an algorithm for the therapy of patients and personalized dispensary observation after an acute period.
To compare structural condition of the bone tissue in the women with verified perinatal infection (vPI) and in healthy pregnant women in the dynamics of gestation. a prospective study in the dynamics of gestation has been performed in 363 pregnant women, 235 of them (group I – main group) with vPI. decrease in bone mineral density (BMd) have been identified already in the 2nd trimester. 128 healthy pregnant women formed control group (group II). ultrasound densitometry was used for the assessment of the structural state of bone tissue. BMd indexes matched normal only in 18.29 % (subgroup IB) of the pregnant women with vPI in the 2nd trimester of pregnancy. osteopenia was diagnosed in 71.91 % (subgroup Ia) in terms of BdI (78.07 ± 1.16) %, z-criterion – (–1.20 ± 0.04) Sd. at 9.78 % of the women under observation (subgroup IC: z-criterion (–2.65 ± 0.24) Sd, BdI – (56.35 ± 2.21) %) osteoporosis was diagnosed. BdI in vPI patients and normal values of BMd (sub- group IB) was (86.45 ± 0.74) %, z-criterion – (–0.90 ± 0.04) Sd. In the dynamics of gesta- tion there were significant losses of BMd in both groups, at vPI BMd losses were more pro- nounced. Probably, the syndrome of systemic inflammatory response may cause BMd loss or exacerbate an existing bone pathology.
Aim: To analyse the legal regulation of the provision of psychological assistance during the coronavirus pandemic. materials and methods: The research methods were chosen with the aim of the study in mind. In order to establish objectivity and validity of scientific provisions, conclusions, during the research, a set of general scientific and special scientific methods was used, in particular such as: (1) the formal legal method was used to analyse the legal and ethical foundations for providing psychological assistance during the coronavirus pandemic; (2) using the comparative legal method, the approaches of national legislation and international standards to the provision of psychological assistance during the COVID-19 pandemic were clarified; (3) the forecasting and modeling method was used to develop practical recommendations regarding the importance of analyzing the legal regulation of the provision of psychological assistance during the coronavirus pandemic and others in the future; (4) the method of systems analysis made it possible to study the legal regulation of the provision of psychological assistance during the coronavirus pandemic; (5) the historical and legal method made it possible to identify the features of the evolution of legal regulation of the provision of psychological assistance during pandemics. Conclusions: The COVID-19 pandemic has exacerbated existing health deficiencies, including a shortage of psychologists. States should initiate medical training programs, including for psychologists and psychotherapists. It should be noted that psychological assistance during a coronavirus pandemic should be based on the following principles: accessibility; continuity; focus; interdisciplinary; educational nature of interventions.
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