BLEEDING DURING LATE PREGNANCY AND LABOR. POSSIBILITIES OF ORGAN-SPARING SURGERY


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Abstract

Objective. To define the possibility and expediency of organ-sparing surgery in patients with massive obstetric hemorrhage of various etiologies. Subjects and methods. The data of histories of labor and delivery accompanied by bleeding were analyzed in 444 patients, including 112 with hypotonic uterine hemorrhage, 111 with placenta previa growing into a uterine scar after cesarean section, 214 with uterine rupture, and 7 with premature detachment of the normally situated placenta accompanied by the Couvelaire uterus. To stop bleeding, all the patients underwent surgery or angiosurgical hemostasis. Results. Organ-sparing surgery using up-to-date technologies (instrumental reinfusion of autoerythrocyte suspension, uterine artery embolization, and temporary balloon occlusion of the common iliac arteries) proved to be effective in treating hypotonic uterine hemorrhage in 94.6% of the patients, placenta previa growing into the uterine scar after cesarean section in 85.6%, uterine rupture in 94.4%, and the Couvelaire uterus due to premature detachment of the normally situated placenta in 100%. Conclusion. When the above technologies are used in third-level hospitals, organ-sparing surgery can be recommended for obstetric complications accompanied by massive blood loss.

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About the authors

Irina Yur'evna Breslav

N.I. Pirogov Russian National Research Medical University

Email: irina_breslav@mail.ru
PhD, Doctoral candidate of Department of Obstetrics and Gynecology, Faculty of Pediatrics Moscow 117997, Ostrovitianova str. 1, Russia

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