Uterine ruptures in modern obstetrics


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Abstract

Objective. To provide the current classification of spontaneous uterine ruptures, which is based on the features of their etiopathogenesis and clinical presentations, and to prove the feasibility of organ-sparing surgery for uterine injury. Materials and methods. A total of 281 histories of labor complicated by uterine rupture were retrospectively analyzed. Births occurred in the obstetric facilities of the Moscow Healthcare Department in 1997 to 2018. Results. In accordance with the proposed classification, the investigators identified patients with violent (n = 6) and spontaneous (n = 275) uterine rupture; among the latter, there were patients with mechanical rupture (n = 35), histopathic rupture along the scar (n = 169), histopathic rupture of the unoperated uterus (n = 59), and mechanohistopathic rupture (n = 12). Conclusion. The leading cause of rupture is a uterine scar after cesarean section and endoscopic myomectomy. The rupture of the operated uterus has clear step-by-step symptoms that a physician of any specialty should know in order to timely save the fetus’s life and to promote the mother’s health. In case of uterine rupture of any etiology, organ-sparing surgery is shown to be expedient during instrumental autoerythrocyte suspension reinfusion that makes it possible not only to reduce operative blood loss, but also to preserve a woman's reproductive function.

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About the authors

Galina M. Savelyeva

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: gms@cfp.ru
MD, PhD, Professor, member of the Russian Academy of Sciences, Professor of the Department of Obstetrics and Gynecology, Pediatric Faculty

Mark A. Kurtser

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: m.kurtser@mcclinics.ru
MD, PhD, Professor, member of the Russian Academy of Sciences, Head of Department of Obstetrics and Gynecology, Pediatric Faculty

Irina Yu. Breslav

MD GROUP Clinical Hospital "MD PROJECT 2000"

Email: irina_breslav@mail.ru
MD, PhD, Head of the Department of Pathology of pregnancy

Alexander G. Konoplyannikov

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: npo.med@gmail.com
MD, PhD, Professor of the Department of Obstetrics and Gynecology, Pediatric Faculty

Oleg A. Latyshkevich

Center for Family Planning and Reproduction, Moscow Healthcare Department

Email: cpsr@zdrav.mos.ru
PhD, Chief

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