Comparative analysis of neonatal sequelae after classic M. Stark and modified cesarean section

Abstract

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.

Comparative analysis of neonatal complications after cesarean section to M. Stark and modified cesarean section in premature birth and congenital malformations of the fetus

“…The condition of newborns in such cases depends primarily on the gestational age, perinatal treatment, the presence of chorioamnionitis, multiple births [1,3,10]. Therefore, the issue of minimizing iatrogenic trauma to the fetus during surgical delivery is one of the crucial values to reduce the negative perinatal consequences [2,4,5,6].…”

“…This method of cesarean section, in which it is proposed to dissect the uterus in layers to the amniotic sac, while maintaining its integrity, was primarily developed to reduce intraoperative blood loss and the risk of damage to the fetus with a scalpel, which occurs in 0.1 -3.1% of the total cesarean section [4, 5,9]. Subsequently, this technique was used to give birth to HIVinfected women to prevent contact of the child with the mother's blood [2,9]. Krasnopolsky VI, 2018; Radzinsky VE, 2015; Fatkullin FI, 2015; Bashmakova NV, 2014 and others.…”

“…The method of operative delivery used in the study is a modification of the classical method of cesarean section by M. Stark, using several new technical approaches [2], which are aimed at improving certain perinatal parameters.…”

“…Despite the increase in the frequency of operative delivery, the incidence and early neonatal mortality of newborns do not tend to decrease [1,2,4,5,10]. The perinatal mortality rate in Ukraine remains without positive changes and in 2018 amounted to 7.0 %%.…”

“…The urgency of the problem lies in the large proportion of premature babies in the structure of perinatal morbidity and mortality. According to the WHO, the frequency of premature birth in the world varies widely -from 4.5% to 16% [1,2,5]. Therefore, the improvement of the technique of abdominal delivery in premature birth and congenital malformations of the fetus creates a certain additional reserve for improving perinatal outcomes.…”