INNOVATIVE APPROACHES TO PREVENTION OF OBSTETRIC HEMORRHAGE DURING ABDOMINAL DELIVERY IN WOMEN WITH PLACENTATION ABNORMALITIES AND HYPERTENSIVE DISORDERS

Abstract

Introduction. The leading factor of obstetric haemorrhage is disrupted uterine contractility. Therefore, at a high risk of obstetric haemorrhage, uterotonic drugs and vasoconstrictors are used immediately after deliverу of a baby. However, the use of ergometrine, carbetocin, and terlipressin can lead to rise in blood pressure that should not be contraindicated for women with preeclampsia.
 The purpose of this study is a search for preventive methods, which ensure the reduction of the frequency of massive obstetric blood loss during caesarean section in women with abnormal placenta ion and hypertensive disorders.
 Materials and methods. We compared the intraoperative volume of blood loss in 18 women of the main group with abnormal placentation and hypertensive disorders (who received prophylactic devascularization of the uterus) and in 35 women of the comparison group with abnormal placentation, but without hypertension (who received 100 µg of carbetocin intravenously during caesarean section).
 Results. No significant difference in the volume of blood loss between women of both groups during both urgent and planned childbirth was noted, despite the fact that the risk of massive blood loss in the main group was significantly higher due to the presence of hypertensive conditions in such women. In the patients of the main group (after devascularization of the uterus), already on day 5 of the postoperative period, the blood flow in the uterine arteries restored and did not differ from that in the patients of the comparison group.
 Conclusion. The technique of devascularization of the uterus in patients with placenta previa and hypertensive conditions can be recommended for the prevention of obstetric haemorrhage.