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.

Over the last twenty years, a sharp perinatal birth rate has registered high perinatal morbidity and mortality in the country. Despite the fact that the number of cesarean sections is constantly increasing, the perinatal mortality rate in the country remains positive and in 2017 was 7.9%%. The purpose of the study was a comparative analysis of the features of the course of the early neonatal period and the frequency of neonatal complications in classical cesarean section according to M. Stark and according to a modified method for improving perinatal outcomes. The selection of patients for the comparative study was performed by type of surgery (classic M. Stark technique or modified technique), which was conducted at the clinical basis of the Department of Obstetrics and Gynecology №1 ONMedU for the period from 2015 to 2018 according to a randomized principle in the obstetric department of the Kherson Regional Clinical Hospital (clinical base of the Department of Obstetrics and Gynecology No. 1 ONMedU). The formation of clinical groups was carried out according to retrospective data from 205 birth histories, the delivery of which was carried out by caesarean section. Statistical processing of the results was carried out using application R of the Microsoft Exel 2003 program. Analysis of quantitative indicators was analyzed using the arithmetic mean value (M) and the error in determining the average value (± m). Qualitative indicators were measured in absolute and relative (percentage) values. The significance of differences in the parametric characteristics in the appropriate groups was evaluated using Student's t test (t - test) and analysis of variance (ANOVA). In the calculations, the differences were considered statistically significant at p <0.05 (95% confidence level (CI) and at p <0.01 (99% confidence level). By using modified access to the abdominal cavity, which involved grasping the peritoneum with the index finger and stretching all layers of the anterior wall in a blunt fashion by two surgeons at the same time, it was almost twice possible to reduce the time to fetal extraction in the main study group (p˂0.001). The condition of newborns on the Apgar scale at 1 and 5 minutes of life in the first clinical group of the study was better (p=0.005). Due to the modified features of fetal extraction, it was possible to reduce the incidence of HID CNS in newborns (p=0.022), to 6 times reduce the need for treatment at the III level (p=0.004). The indicator of early neonatal mortality in the newborns of the first clinical group was zero, whereas in the comparison group 2 cases were recorded. However, the difference is not significant (p=0.223). Thus, the modified Caesarean section improves the overall condition of the newborns according to the Apgar scale at 1 and 5 minutes of life, is accompanied by a decrease in the frequency of some complications in the early neonatal period, creates a certain additional reserve for the improvement of perinatal complications and requires further comprehensive studies.

Intraoperative diagnosis of «sentinel lymph nodes» with objective to select the surgical procedure in gastric and uterus cancers

The aim: To analyze contemporary practical means to improve diagnostics of primary fallopian tube cancer. Materials and methods: Authors analyzed specifics of clinical signs and anamnesis in 152 PFTC patients. Diagnostic capacity of cytological analysis of pathologic vaginal discharge, X-ray contrast methods of examination, sonography, tumor markers, and computed tomography was studied. Own results of PFTC diagnostics using different methods and world practice using MRI, PET-CT and laparoscopy were discussed. Results: Using own observations authors conclude that clinical analysis and complex use of the listed methods allows to mainly determine high risk group patients and set correct preoperative diagnosis in 35% and preliminary diagnosis in 20% of PFTC patients. Conclusions: Complex examination allows to recognize primary fallopian tube cancer on preoperative stage and to avoid inadequate surgical interventions in majority of PFTC patients.

No abstract

Deep infiltrating endometriosis (DIE) in one of the most common reason for surgical treatment due to chronic pelvic pain and/or infertility. The goal of surgery is excision of all visible heterotopias and minimize risk of recurrence of disease and repeated surgeries or improve fertility outcomes. However there are no standardized technique of surgical procedure in DIE. During last 5 year (2010)(2011)(2012)(2013)(2014) we performed 195 laparoscopic operations in patients with DIE with complains of resistant to medical treatment chronic pelvic pain and/or infertility. Our standardized procedure in laparoscopic surgical treatment of DIE include several steps: (1) laparoscopic revision of pelvic and abdominal cavity; (2) adhesiolysis and "second-look" laparoscopic revision, verification of DIE, its localization and stage, ureteres vizualization; (3) surgical treatment of endometriomas (using technique of enucleation and partially ablation); (4) ovarian fixation; (5) lateral peritoneal resection (total or partial); (6) central peritoneal dissection (Duglas dissection with or without vaginal opening and resection of vaginal fornix wall); ( 7) shaving or resection of endometriosis nodules in rectum, bladder, sigmoid colon, ureter, appendectomy if needed; (8) evacuation of macropreparation, inspection of validity of pelvic organs (bladder, rectum, colon); (9) haemostasis and (10) drainage. In our clinic we observed all favorable results of the operations. Rectal shaving was performed in 35 cases, bowel resection in 17, bladder resectionin 10, ureterolysis -in 6, appendectomy -in 11 cases, posterior vaginal fornix resection -in 40 cases. Recurrence of DIE symptoms we detected in 15 patients who did not received or withdrawn postoperative treatment or did not conceive at 12-18 months of observation.Conclusion: standardization of laparoscopic surgical procedure in deep infiltrating endometriosis improves short and long-term results of treatment.

No abstract

В.М. ЗАПОРОЖАН д. мед. н., професор, академік НАМН України, ректор Одеського національного медичного університету, завідувач кафедри акушерства та гінекології № 1 І.З. ГЛАДЧУК д. мед. н., професор кафедри акушерства та гінекології № 1 Одеського національного медичного університету Н.М. РОЖКОВСЬКА д. мед. н., професор кафедри акушерства та гінекології № 1 Одеського національного медичного університету А.Г. ВОЛЯНСЬКА к. мед. н., доцент кафедри акушерства та гінекології № 1 Одеського національного медичного університету В.Л. КОЖАКОВ к. мед. н., асистент кафедри акушерства та гінекології № 1 Одеського національного медичного університету