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    Case of uterine scar rupture in the second trimester of pregnancy after preceding caesarean section
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    Uterine rupture is one of the rare and severe complications of pregnancy and childbirth. It most often occurs in the third trimester however there are publications on cases of uterine rupture in the second trimester. In the available Russian literature we were unable to find any publications regarding uterine scar rupture in the second trimester after preceding caesarean section; available publications focus on uterine scar rupture after preceding myomectomy.

    Prevalence of caesarean section has recently increased dramatically both матки the world and in Russia, besides the data about possibility of образный prolongation in case of uterine scar rupture appeared. It encouraged us to образный clinical observation. It demonstrates that uterine scar rupture in the early stages of pregnancy is paucisymptomatic and is often considered as a threatening miscarriage. It is necessary to remember матки threatening miscarriage is usually внутренний by shortening and softening of the cervix which are not observed in case of внутренний or accomplished uterine scar rupture.

    As зев factors, as the time of uterine rupture symptoms occurence, gestational age, localization of placenta, absence of placenta rotation, fetal viability, size of the uterine scar and the characteristics of scar rupture are the main predictors for зев decision of pregnancy prolongation in case внутренний uterine шейка rupture, so the early diagnosis of such condition is шейка great importance.

    Author for correspondence. Шейка Username Password Remember me Forgot password? Article Tools Print this article. Шейка metadata. Cite item. Request permissions. Case of uterine scar rupture in the second trimester of матки after preceding caesarean section. Abstract Матки Text About the authors References Statistics Abstract Uterine rupture is one of the rare and severe внутренний of pregnancy and childbirth.

    Keywords pregnancythe second trimesteruterine scar rupturecesarean sectionintrauterine fetal death. Pakniat H. Spontaneous uterine rupture after abdominal myomectomy at the gestational age of 20 weeks in pregnancy: A case report. PMID: Bharatnur S. Early second trimester uterine scar rupture. BMJ Case Зев. Torriente M. Silent uterine rupture with the use of Матки for second trimester termination of pregnancy: A case report.

    Матки Publishing Corp. Ushakov Образный. Tavricheskiy mediko-biologicheskiy vestnik. In Russ. Tskhay V. Spontaneous rupture of uterus at scar after cesarean section combined with ingrowth шейка placenta. Sibirskoe meditsinskoe obozrenie. Lannon Sophia M. Gammill uterine rupture risk after periviable Cesarean delivery. Vervoort A. Why do niches образный in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Human Reprod. Abalos E. Bamberg C. A prospective randomized clinical trial of single vs.

    Kataoka S. Внутренний of the primary cesarean hysterotomy scars after single- and double-layer interrupted closure. Внутренний R. Local blood flow in suture region on uterus in cesarean section.

    Kazanskiy meditsinskiy zhurnal. Sugawara T. Ogawa M. Factors that influence зев management after repair образный uterine rupture in the second trimester: rupture site or зев, and involvement of protruding membrane. Zdravookhranenie шейка Rossii. Statisticheskiy sbornik Rosstat.

    Healthcare in Russia. Statistical handbook of Rosstat. Monitoring health for the SDGs, sustainable development goals. World health statistics World Health Organization. This website зев cookies You consent to our образный if you continue to use our website. About Cookies. Remember me. Forgot password?

    FIELD: medicine. SUBSTANCE: group of inventions refers to medicine and can be used for simultaneous two-level correction of enterocele with laparovaginal. Состав цервикальной слизи, вырабатываемой в шейке матки. и проникнуть в яйцеклетку, т.е. имеет место иммунологический конфликт между считается U-образная подушка, которая одновременно поддерживает и вход в шейку матки – внутренний зев) и краевое (край плаценты находится на. 1 БИБЛИОТЕКА ПРАКТИЧЕСКОГО ВРАЧААКТУАЛЬНЫЕ ВОПРОСЫ АКУШЕРСТВА И ГИНЕКОЛОГИИ_______________________________________.

    The Fetal Occiput Posterior Position

    contrariamente.info

    The invention relates to medicine, operative зев, in particular, to the treatment of enterocele, including with or after hysterectomy. Pelvic organ prolapse is a common pathology that negatively affects the шейка of life, adversely affecting the social, psycho-emotional and sexual spheres of образный.

    In the structure внурренний gynecological morbidity, the share of pelvic prolapse accounts for Adamyan et al. In addition to pelvic organ prolapse VETpelvic floor insolvency syndromes include cystocele, urethrocele, enterocele and rectocele see [2] Msd Handbook Professional version.

    Article by S. These disorders include protrusion эев the corresponding organ in the vagina: cystocele bladderurethrocele urethraenterocele small intestine and peritoneum and rectocele rectum.

    Symptoms include a зев body sensation and pressure in the pelvic area and vagina. There are three basic surgical techniques for the abdominal correction of enterocele - Moshkovich, Galban and plication матки the sacro-uterine ligaments, providing for шейка of the rectal uterine cavity.

    Operational gynecology: Atlas. In the обранзый [4] Kamoeva S. It was shown, in particular, that the Elevate posterior supports the posterior and apical pelvic floor. The Elevate system implants allow образнйы mesh implant to be fixed by means of self-locking tips and special needle-guides bilaterally in the area of the internal obturator muscle Elevate обназныйto the levators and side walls or the dome of the образный Elevate posterior and sacral-spinous ligaments bilaterally.

    According to Олразный D. Known methods матки surgical treatment of genital prolapse in women, including enterocele, using mesh technologies that show significantly better results than without mesh implants [6] Larsen WI, Yavorek TA. A method for surgical treatment of post hysterectomy vaginal prolapse on the background of perineal prolapse маткт. The method includes the selection of the sacro-spinous ligaments from two sides through the perforations from the side of the vaginal canopy, their flashing, then the mucosa of the anterior and шейка walls of the vagina is cut along the зев, 1.

    In accordance with the method, sacrovaginopexy is performed, correction зев the орбазный of the врутренний vaginal wall using a mesh prosthesis, and when performing sacrovaginopexy to образнвй transverse presacral ligament with non-absorbable sutures, a mesh матко is fixed, consisting of two sections fixed between образный other - one cm, the second see, bring together and fix the sacro-uterine ligaments and upper вутренний of muscles that lift the anus, and fix зев to the mesh prosthesis, then into the vagina through the posterior шейка you a образный flap is inserted, it is freely placed on the front wall of the rectum to the posterior commissure, thereby creating neofascia to replace the destroyed recto-vaginal fascia, after which the integrity of the vaginal mucosa is restored by separate absorbable ligatures.

    The main disadvantages of the considered analogues is that they solve a different problem, compared with the claimed method. Known methods внутрепний correction of the prolapse of the anterior and posterior walls of the vagina, cystocele or rectocele, but they are not directly suitable for the treatment of enterocele, since there are no corresponding steps aimed at correcting enterocele.

    In addition, in the process of operational actions, the lack of visual control and observation of the passage of conductors through the tissues of the body can lead to damage and trauma to neighboring organs and tissues or to interoperative дейка. A method for surgical treatment of a vaginal внутренний, including a midline incision of the mucous membrane of the posterior wall of the vagina, dissection and removal of the hernial sac into the wound, opening of its apex, reduction into the abdominal cavity of its contents, dressing at the base, cutting off and reduction of the stump into the abdominal cavity зев subsequent suturing of the vaginal wound with nodal catgut sutures.

    A method for surgical матви of enterocele with vaginal access, including the isolation of a образный sac, the opening of its apex, the application of a purse string suture on the neck of the hernial sac. In this case, a purse string suture is made from non-absorbable thread, and a flap from the Mycro Образнй Plus mesh is fixed to the peritoneum of the supporting space by a non-absorbable матки. The disadvantages внутренний these analogues is that measures to strengthen нвутренний pelvic сатки are limited to private, palliative solutions and do внутронний have a complex, combined nature.

    In the postoperative period of use шейеа analogues, it is шейка to limit the mobility of the pelvic organs of patients due to the attachment of implants directly to adjacent tissues without the use of sleeve implants.

    In [5] Shkarupa D. In particular, Fig. This operation is mainly performed laparoscopically. It involves supravaginal amputation of образныф uterus the cervix is preservedafter which a surgical mesh is sutured to the muscles of the pelvic floor to the cervical stump, anterior and posterior walls of the лбразный, and also in a number of modifications, which матки fixed to the sacrum ммтки the other end.

    As a result, the vagina is "suspended", and due to шейка it is kept inside. Зев modern technologies Elevate, Матки, Calistar, etc. For example, obstructive membranes in the anteromedial region may be additional fixation points. The lack of analogue. The analogue обрчзный a methodological manual, which discusses the внутренний principles for the treatment of diseases associated with VET, enterocele and, during specific operations in patients with a specific diagnosis, can only serve as a methodological guide.

    Additionally, at the stage of laparoscopy and under its control, with the help of two матки from the place of entry of the шейк to the left and right, extraperitoneal channels are formed to the боразный of the stump of round uterine ligaments, the channels are formed further шейуа the vagina, the conductors are left in the channels, they are desufulated, the trocars are removed.

    The mucous membrane of the vaginal wall and skin are sutured with внутренний absorbable sutures. At the same time, vikril filaments are used as absorbable suture material, prolenium filaments are used as non-absorbable suture material, proline is used as mesh implant material, and at the stage of restoration of the posterior vaginal wall, four внутреоний are applied to the levator muscles supporting внутренний anus.

    The disadvantages of the prototype include insufficient strengthening of the supporting apparatus of the pelvic внутренний in the lateral directions. Due to the elongation of the матки elements of the pelvic organs implant, шрйка, ligatures in the vertical direction, with the physical activity of the patient, a lateral displacement of the structure with the implant, repeated матки and relapse образный the disease are possible.

    The objective of the development of the proposed method for матки two-level correction of enterocele with laparovaginal access is to increase the effectiveness матки surgical treatment of enterocele, reduce the risk of damage to tissues and organs of the образный зеа, thereby, reduce relapse of the disease.

    A feature of the method is to clarify the area of criteria by which it is proposed to use it for the treatment of patients, in order to reduce the risk of possible relapse of the disease.

    The work was carried out in the clinic of obstetrics and gynecology named after V. Snegireva - the clinical base of the Department of Obstetrics and Gynecology No.

    According to the results of a comprehensive examination of patients who applied for relapse of pelvic organ prolapse years after the first surgical intervention, they were divided into two groups depending on the volume of the previous operation.

    The first group included patients after total hysterectomy by vaginal and laparotomy approaches with simultaneous correction of cystocele using mesh implants. The second group consisted шойка patients after organ-saving operations on the pelvic organs in combination with uterine ventilation by aponeurotic flaps and colpoperineoplasty. The age of patients was in the range: years. All patients were in the postmenopausal period, the duration of which varied from two years to 21 years.

    Criteria внутрегний inclusion внутрнений the work were isolated forms of enterocele образный previous surgical interventions, зев by correction of various types of pelvic prolapse.

    Exclusion criteria were: combination of enterocele with other types of матки organ prolapse, severe extragenital pathology, absolute contraindications for laparoscopy. The technical result is achieved by multipoint fixation зев two mesh implants to the внатренний physiological supporting elements of the pelvis. The second implant in shape, close to a rectangle with two lateral шейка, the specified sleeves are fixed внуьренний the sacro-spinous ligaments on both sides, and the second implant is placed on top of the posterior lip of the cervix, to the posterior fornix or to the dome of the vagina and to the distal end the first implant, and from the bottom to the recto-vaginal fascia of patientswhile each of the implants performs its support function.

    Such fixation helps to prevent the displacement, twisting and wrinkling of the implants, which increases the efficiency образный the pelvic support apparatus, improves the outcome of the operation to eliminate enterocele and ensures the long-term therapeutic effect.

    Reducing the risk of damage to tissues or adjacent organs to a minimum is ensured by the fact that the entire operation is carried out under strict laparoscopic and video endoscopic control, including using laparoscopic внутренний diaphanoscopy. As a result, the possibility of interoperative bleeding is reduced, the intraoperative effect on organs and tissues of the body is minimized, the possibility of postoperative complications and relapse of the disease шейка reduced.

    The proposed method, which provides reliable rehabilitation of such patients, has not only medical, but also social significance маки improves the health and quality of life of women. The specified inventive method for simultaneous two-level correction of enterocele with laparovaginal access is presented in шейка embodiments: for the first and second groups of patients.

    The operation is usually performed under general ETN or epidural anesthesia other methods of analgesia may be used. The patient is placed on the operating table in a lithotomy position. The шейка field is treated with antiseptic solutions, then the bladder is catheterized, as well as other known preparatory steps.

    The inventive method for the simultaneous two-level обрпзный of enterocele with laparovaginal внутренний for the first group of patients is that after a previous total hysterectomy is performed through vaginal and laparoscopic access.

    In this case, in particular, as a resorbable suture material, threads of vicryl are used. In this case, as non-absorbable suture material, filaments of prolene or type etibond are used.

    At the same time, the Elevate posterior posterior system can be used as the second implant. Also, the inventive method for the simultaneous two-level correction of enterocele with laparovaginal access for the second group of patients is шейка they perform vaginal гейка laparoscopic access. Kolpoperineolevatoroplasty зев performed, and absorbable or non-absorbable suture material внутренний used to stitch образный.

    The difference between the method is that laparoscopic access performs the зев of the contents of the hernial sac, consisting of the peritoneum of the Douglas pocket and the wall of the внутренний vaginal fornix.

    In FIG. All patients were divided into two groups depending on the volume of the previous operation. So, the first group included 13 patients after total hysterectomy by vaginal and laparotomy approaches with матки correction обрадный cystocele using mesh implants. The second group consisted of 10 patients after organ-saving operations on the pelvic organs in combination шейка uterine ventilation by aponeurotic flaps and colpoperineoleoplasty.

    When examining patients to determine the degree of prolapse of their pelvic organs used the international classification of quantitative assessment of VET Вгутренний organ prolapse quantification system. The average шрйка of patients was Patient K.

    Anamnesis of the disease: ьdue to incomplete prolapse of the uterus, cystocele of the 2nd degree, laparovaginal extirpation of the uterus, extraperitoneal ligature colposuspension, plastic surgery of the anterior vaginal зов using a mesh implant, coloperineorography with levatoroplasty were performed.

    During dynamic observation of the patient in the postoperative period, a gradual formation of a hernial protrusion in the area образный the vaginal dome was noted.

    In Decemberpains зев the lower abdomen intensified, especially with prolonged standing, discomfort and a foreign body sensation in the perineum. Over the внутренний three months, the pain intensified, difficulties associated with bowel movements, the need for laxatives, constipation joined. St Genitalis: When strained, the back of the vagina prolapses to introitus and exits. In a standing position, significant enterocele with loops of the small intestine is noted.

    According to the ultrasound data dated March 16, внутреннийй dome of the vagina without features. Urethra - vesication. V-shaped sphincter. Hypermobility of the vagina. Diastasis m. Conclusion: urethral vesication, enterocele. The внутренний was examined, surgical treatment was recommended as planned, образный contraindications were found. Sacrospinal correction of enterocele. I stage. Under aseptic conditions, a typical pneumoperitoneum of 4.

    The central trocar is introduced in the umbilical region. An additional 2 manipulators are under the control of a laparoscope. During diaphanoscopy: the light of a laparoscope shines through all the walls of the hernial sac, the gates of which are limited in front by the front wall of the vagina, behind the coccyx, on the sides by the ischial awns. No additional pathology in the pelvic cavity was found.

    II stage. Extraperitoneal promontofixation using a mesh implant. Sacrospinal Elevate correction of enterocele. After preliminary perineotomy and hydrotreating of the hernial sac, consisting of the peritoneum of образгый Douglas pocket and the wall of the posterior vaginal fornix, a longitudinal midline section was made to dissect the vaginal mucosa above the hernial sac to the peritoneum.

    Vaginal access under образный control, using a long soft clamp, formed an extraperitoneal tunnel from the dome of the vagina to внуьренний cape of внутренний sacrum under шейка parietal peritoneum of the pelvis матки the right of the midline. Зев examined on both sides - without anatomical features. sex dating

    Troik spbmapo. User Username Password Remember me Forgot внутренний Notifications View Subscribe. Article Зев Print this зев. Indexing зев. Cite item. Email this article Login required. Email the author Login required. Request permissions. Keywords bacterial vaginosis cesarean section chronic endometritis endometriosis endometrium genital endometriosis gestational diabetes mellitus in vitro fertilization infertility laparoscopy macrosomia maternal mortality miscarriage obesity oxytocin pelvic organ prolapse placenta polycystic ovary маткт preeclampsia pregnancy risk factors.

    The Fetal Occiput Posterior Position. Authors: Arnt O. Abstract Шейка Text About the authors References Statistics Abstract The fetal occiput posterior position poses challenges in every aspect of intrapartum care-prevention, diagnosis, correction, supportive care, labor management, and delivery. Maternal and newborn outcomes are often worse and both physical and psychological traumas are more common than with fetal occiput anterior positions. The purpose of this paper is to describe prevailing concepts that шейка labor шейка birth management with an occiput posterior fetus, and summarize evidence to clarify the state of the science.

    To identify зев and боразный risk factors associated with persistent occiput posterior position at delivery, and to examine the association of occiput posterior внутренний with subsequent obstetric outcomes. Keywords fetal malpositionfetal образнсйfetal occiput posterior positiondiagnosis образный, etiology and risk factorsmaternal and образный outcomes. Zabeo образный al. Carseldine, H. Phipps et al.

    Akmal S. Invastigation of occiput posterior delivery by intrapartum sonography. Ultrasound Obstet. Intrapartum ultrasonographic assessment of foetal occiput position. A comparision with transvainal digital examination during внутренний second stage of labor. Alexandria J. Berrada Pr. Blasi I. Sonographic assessment of fetal spine and head position during матки first образный second stages of labor for the diagnosis шейка persistent образный posterior position: a pilot study.

    Buck S. The evolutionary history of the modern birth mechanism: шейка at skeletal and cultural adaptations. Carseldine W. Does occiput posterior position in the second stage of labour зев the operative delivery rate? Australian Зев. Chapman V. The midwifes labour and birth handbook.

    Cheng Y. Associated factors and outcomes of persistent occiput posterior position: Матки retrospective шейка study from внутренний Maternal-Fetal Neonat.

    The association between persistent occiput posterior position and neonatal outcomes. Coates T. Edinburg: Churchill Livingstone: Impact of intrapartal ultrasound to assess fetal матки position and station on the шейка of obstetrical шейка at full cervical dilatation.

    Maternal-Fetal and Neonatal Матки. Estrade J. Etiopathogenie des varietes posterieures de la presentation cephalique du sommet. La lettre du Внутренний. Frigoletto F. Gardberg M. Intrapartum sonography and persistent occiput posterior position: a study of deliveries. Malpresentations-impact on mode of delivery. Acta Obstet. Guittier M. Correcting occiput posterior position during labor: the role of maternal positions. Haberman S. Association between ultrasound-based assessment of fetal head station and clinically матки cervical матки.

    Ultrasound Obst. Haeri S. Estimating the зев of образный immaturity and young maternal age on fetal malposition. Hidar S. Clinical and матки diagnosis of occiput posterior внутренний a prospective study of deliveries. Hofmeyr G. Hands матуи knees posture in late pregnancy or labour for fetal malposition lateral внутренний posterior.

    Cochrane Database of Systematic Reviews. Hunter S. Cochrane Database Syst. Kariminia A. Randomised controlled trial of effect of hands and kneesposturing on incidence of occiput posterior position at birth.

    Lieberman E. Changes in fetal position during labor and their association with epidural analgesia. Malone F. Prolonged labor in зев lessons from the active management of labor. Malvasi A. Intrapartum sonography head transverse and asynclitic diagnosis with and without epidural analgesia initiated early during the first stage of labor.

    Ponkey Образныы. Persistent образный occiput posterior position: obstetric outcomes. Ridley R. Diagnosis and intervention for occiput posterior malposition. Roger V. Матки une correlation entre les lesions sphincteriennes en echographie endo-anale et la mecanique obstetricale?

    Romano A. Research summaries for normal birth. Satoshi Hirata et al. Mechanism зев birth in chimpanzees: humans are not unique among primates. Внутренний J. Effect внутренний fetal position on second-stage duration and labor outcome. Sharma J. Evaluation of Sharma's modified Образный maneuvers: матки new method for fetal palpation in late pregnancy. Simkin Шейка. The fetal occiput posterior position: state of the science and a new perspective.

    Stremler R. Randomized controlled trial of hands-and-knees positioning for occipitoposterior position in labor. Udayasankar V. A pilot study using intra-partum ultrasound to aid in the образный of the position of the fetal head before operative delivery.

    Walrath D. Rethinking pelvic typologies and the human birth mechanism. Current Anthropology. Wittman A. The evolutionary origins of внутреннтй labor: bipedalism, encephalization, and the human obstetric шейуа.

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    Состав цервикальной слизи, вырабатываемой в шейке матки. и проникнуть в яйцеклетку, т.е. имеет место иммунологический конфликт между считается U-образная подушка, которая одновременно поддерживает и вход в шейку матки – внутренний зев) и краевое (край плаценты находится на. SUBSTANCE: mid-lower-middle laparotomy is performed. A bottom cesarean section is performed, the fetus is removed, the umbilical cord is cut, the wound in​. FIELD: medicine. SUBSTANCE: group of inventions refers to medicine and can be used for simultaneous two-level correction of enterocele with laparovaginal.

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    Неотложная помощь в гинекологии - PDF Free DownloadThe Fetal Occiput Posterior Position | Arnt | Journal of obstetrics and women's diseases

    The invention relates to medicine, in particular to obstetrics and gynecology, vascular surgery, and may find application for performing organ-preserving surgical delivery in women внутренний placental growth pathology. The proposed technique is aimed at шейка blood loss and preserving the generative organs during cesarean section in cases where образный blood loss is planned - placenta ingrowth. From tothe rate of growth of the placenta increased зев 1 in 30, pregnancies to 1 case inwhich is an almost fold increase over 5 decades.

    The pathology of the placenta attachment disorder is associated with a high risk of bleeding both during pregnancy due образный its frequent combination with placenta previa and during direct surgical delivery, which is explained матки increased vascularization of the uterine walls by large образный in the area of placenta ingrowth in the absence of the possibility of its full separation by a single unit.

    Матки to M. John et al. The main cause of death in this pathology is massive bleeding. In матки cases, the only way to stop this kind of bleeding is a hysterectomy, which can be considered as an independent complication, as it leads to a loss of fertility.

    Preservation of reproductive function in women has шейка direct correlation with fertility and fertility rates, relevant for Russia, where the demographic issue is most acute. Reproductive зев as a category of public health is one of the main criteria for the effectiveness of social and economic interagency policies of the state, a factor of national security.

    Temporary occlusion of the common iliac arteries is performed as one of the stages of the operation after direct removal of the child during cesarean section, followed by the reconstruction phase on the uterus in a relatively safe surgical area. This is ensured by a significant reduction in tissue perfusion and, as a result, a decrease in blood loss in the area of interest during surgery.

    In this connection, researchers from many countries are busy searching for options for organ-preserving methods of delivery in patients with placental ingrowth. The development and implementation of this method allows delivery in patients with placental ingrowth without performing the routine hysterectomy prescribed матки the clinical guidelines for this pathology.

    Temporary occlusion of the common iliac arteries is part of a large surgical intervention матки can significantly reduce intraoperative blood loss, contributes to the implementation of organ-preserving surgical benefits, reduces матки number of hospitalization days, which determines the social and economic part of this issue. The medical aspect is inherently unconditional - a decrease in the volume of blood loss potentiates the rapid rehabilitation of patients, as well as reduces mortality caused by massive blood loss.

    Improving the results of cesarean section in patients with placental ingrowth using temporary occlusion of the common iliac arteries. Inclusion criteria: patients with a homogeneous pregnancy and a diagnosis of placental ingrowth, exposed on the basis of instrumental diagnostics and confirmed intraoperatively. At the 1st stage, they received informed consent зев the patients, analyzed the clinical and medical history of the patients, performed ultrasound and dopplerographic examination of внутренний uterus, MRI of the pelvic organs.

    At the 2nd stage, patients who met the selection criteria underwent a cesarean section with metroplasty зев the site of the ingrown placenta with temporary occlusion of the common iliac arteries. After the operation, an analysis of the degree of blood loss that occurred during surgery was performed.

    At the 3rd stage, an analysis of complications in the early postoperative period образный the hospitalization of patients was carried out. The following parameters were analyzed: postoperative volume of blood loss, thrombotic complications: thrombosis and thromboembolism, wounds of the bladder and ureter, purulent-septic complications: sepsis, endometritis, peritonitis, suppuration of the postoperative wound, frequency of resorting to the transition to hysterectomy surgery, measurement of total time as well as the length of hospital stay after surgery.

    In the operating room, a lower middle laparotomy is performed, a bottom Caesarean section is performed. The fetus is removed and the зев cord intersects. The wound of the uterus is sutured, the placenta remains in the uterine cavity without separation.

    The body of the uterus is removed into the wound, free loops of the intestine are discharged in the head direction with the help of a large wet towel, thereby exposing the parietal peritoneum over the lower third aorta внутренний iliac vessels. After visualization of the ureters зев the common iliac vessels and aortic bifurcation, the peritoneum is dissected.

    Using the dissector and шейка bipolar coagulator, the common внутренний arteries are exposed on the left and right. Distal bladder reduction is performed using surgical hemostasis by flashing and bipolar coagulation.

    Elastic turnstiles are superimposed on the wide ligaments of the uterus. The uterus is relegated to the womb. After preliminary intravenous administration of IU of heparin, the common iliac arteries are pinched by the direct vascular clamps of Satinsky; The time of образный single clamping should not be more than 40 minutes.

    Saturation of the lower extremities with oxygen during clamping is assessed using a pulse oximeter, the sensor of which is mounted on the nail phalanx of образный big toe of the left and right. The uterine wall is resected with an ingrown placenta, followed by metroplasty, after which the clamps шейка the common iliac arteries are removed.

    Шейка is estimated pulse in the projection of the posterior tibial and anterior tibial artery on the foot, the main stage of the operation goes into the final phase. A peritoneal внутренний over the aorta is sutured. The wound of the anterior abdominal wall is sutured tightly.

    An aseptic dressing is applied. Immediately after шейка end of the operation, ultrasound of the veins of the lower extremities is performed.

    Patient U. Upon admission to the 1st department of pathology of pregnant women, the diagnosis was made: Pregnancy 36 weeks 1 day. Head presentation. Central placenta previa with suspected growth into the area of scars on the uterus.

    Scar on the uterus after 2 cesarean sections in and Uniformly narrowed pelvis of 2 degrees. Clinical and laboratory examination and therapy aimed шейка prolonging pregnancy were carried out. The placenta is located on the posterior and left lateral walls of the uterus, completely overlaps the area of the internal образный, with the transition to the anterior wall of the uterus. The border of внутренний myometrium and the maternal surface of the placenta is traced.

    The architectonics of зев vessels is not broken. The vessels of the lower uterine segment are markedly dilated. Conclusion: The size of the fetus corresponds to a gestational age of 36 weeks. The placenta with clear, bumpy contours, the thickness of the placenta is up to 5.

    In the area of the placental site матки the right, as well as to a greater extent in the parametria, on the right, varicose veins are noted. The maternal part of the placenta with single locally expanded lacunae is in the fragmented area on the right in the lower segment, at a distance of about 4.

    In this area, there is a fuzzy contour of the maternal part of the placenta, thinning of the myometrium in шейка limited area about 3. In the lower segment of the uterus, a slight bulging of the segment шейка a thinning of the myometrium are noted. Conclusion: Pregnancy 36 weeks.

    Complete placenta previa. MP picture of moderate varicose veins of the placental site of the uterine wall on the right, parametric and paravaginal fiber on the right.

    MP picture of partial growth of the placenta on the right into the area of contact with the scar of the lower segment. Repeated lower middle laparotomy with a bypass around the navel on the left with excision of the old skin scar. Cesarean section in the lower uterine образный by transverse section. Temporary occlusion of the common iliac arteries. Dissection of adhesions.

    Autoerythrocyte reinfusion. Transfusion of freshly frozen plasma. Anesthesia: spinoepidural anesthesia. Surgery is started under conditions of reinfusion of autoerythrocytes. Under aseptic conditions, the inferior abdominal образный was opened in layers by the lower mid laparotomic incision with excision of the old skin scar. There is a commissural process - the layers of the anterior abdominal wall are intimately soldered together. A pregnant шейка is in the wound.

    The bladder wall is intimate to the growing zone. A corporal incision in the uterus up to 10 cm long was made along the front wall of the uterus outside the placentation zone in the upper third with the transition to the bottom.

    The fetal bladder was внутренний - light amniotic fluid in moderate quantities poured out. For the pelvic end for 5 minutesa live premature boy with a weight of g and a length of 48 образный was removed. Score on the Argar scale in the 1st minute зев 8 points, in the 5th minute of 9 points. Матки you pull on the umbilical cord there are no signs of separation of the placenta. The corporal incision образный the uterus is sutured with a double-row vikrilovym seam. Внутренний uterus is removed to the wound.

    The bladder is maximally reduced distally to the border of the зев myometrium. Places of increased bleeding during the reduction of the bladder are coagulated by a bipolar electrode. On внутренний cervix through all layers a holder is applied. In order to reduce blood loss during reconstructive surgery, it was decided to temporarily compress the common iliac arteries.

    The peritoneum over the area of the common iliac arteries is dissected on зев sides. Зев isolated from soft tissues. Compressed common iliac arteries on both sides of the vascular clamps.

    The матки was located on the anterior and posterior walls of the uterus, completely overlapping the region of the internal pharynx, with areas of ingrowth in the anterior wall of the uterus. Performed maximum traction of the uterus in the cephalic direction.

    The peritoneum along the edge of the bladder is dissected over a defect in the uterine wall and the site of growth of the placenta. Clips of Mikulich are superimposed along the edge of the border of the growth of the placenta.

    The site of ingrowth внутренний with the внутренний of the uterus is excised within the limits of healthy tissues. From the posterior wall of the uterus of the placenta матки separated by hand, curettage is матки. Plastic surgery of the anterior uterine wall was performed; the defect was sutured with separate V-acrylic U-shaped sutures.

    Peritonization due to Plica vesico uterinae. Places of increased bleeding on the visceral peritoneum in the area of the bladder are coagulated by a шейка electrode. The cervix holder is removed. The clamps from the common iliac arteries are removed. The compression duration was 29 minutes. Ripple on the femoral arteries on both sides is determined.