CURRENT APPROACHES TO MANAGING PUERPERAS WITH BIRTH INJURIES

Objective. To improve and optimize the postpartum period in puerperas with soft tissue injuries in the generative passage via a differentiated approach, by taking into account the infection risk and by using the current highly effective means for suture care. Subject and methods. Birth history data over five years (2008-2012) from the records of three Volgograd maternity hospitals were retrospectively analyzed to specify the incidence of birth injury in the population. The long-term consequences of birth injuries were studied and their impact on the reproductive health and quality of life was evaluated in the women, by analyzing the birth histories of patients admitted to hospital to be surgically treated for cicatricial deformity of the perineum and varying descent of the vaginal wall, as well as for genital prolapses requiring surgical treatment. Clinical investigations were designed as an open-label randomized controlled trial. The puerperas were randomized into two groups: 1) 48 with soft tissues injuries in the parturient canal who had received conventional suture care (a comparison group); 2) 73 patients had been managed by the improved procedure (a study group). The degree of risk for parturient infectious complications and the pattern of suture healing were assessed in all the purperas. Results. The retrospective analysis of the birth history data has shown that every three (31%) births are accompanied by rupture of the vaginal walls or vulvar lips; the rupture rates for the cervix uteri and peritoneum were 8.7 and 9%, respectively; however, with consideration for episeo- and perineotomies, peritoneal injury was observed in every three (36.4%) parturients. The other component of this problem is the peculiarities of tissue healing. The postpartum period and puerperal ulcer healing patterns were analyzed in the puerparas of the compared groups during the clinical investigation. All the puerparas receiving depantol suppositories in combination with vaginal treatment with hexicon showed primary intention healing; all the puerperas of this group and their newborn infants were discharged on days 6-7 postpartum. Conclusion. The retrospective analysis of maternity hospital birth history data over 5 years suggest that the rate of birth trauma remains high and has no declining tendency, which has an extremely negative impact on the reproductive potential and quality of life in the women. This problem must be solved in two directions: on the one hand, a reduction in the rate of soft tissue injuries in the generative passage should be achieved and, on the other, postpartum management optimization is required in puerperas with these injuries; in this connection it is proposed to identify three degrees of infection risk and to implement remedial measures differentially, by applying the current highly effective means for suture care. The clinical investigation of depantol used to manage puerperas with soft tissue injuries in the generative passage suggests its higher efficacy due to rapid regeneration than conventional suture care methods. The use of depantol is promising in managing puerperas with soft tissue injuries in the postpartum units of the maternity hospitals.

birth injuries, reproductive health, differentiated approach, depantol