RATIONAL DELIVERY FOR WOMEN WITH UTERAL FIBROID AND BREECH PRESENTATION AND DECREASING THE INDEXES OF MATERNAL MORBIDIY

Abstract

Listen

Translate article

Introduction. Breech presentation and uterine fibroids in women are clinical cases which occur more and more frequently in modern obstetric practice. Regarding this issue, scientists’ attention is drawn to the aspect of surgical delivery for such patients, which unavoidably requires taking into account both unplanned necessity of expanding the volume of caesarian section (myomectomy, uterine removal) and increased intraoperative blood loss. Aim. Decreasing the indexes of maternal morbidity in women with uterine fibroid and breech presentation by developing the optimal approach to their delivery.Materials and methods. An analysis of primiparae and secundiparae with uterine fibroid and with single full-term pregnancy with breech presentation has taken place and constituted the main group (MG) (n=40). The control group (CG) (n=40) consisted of primiparae and secundiparae with single full-term pregnancy with breech presentation without uterine fibroid. All the women had their deliveries at Odesa Regional Perinatal Centre. The data has been processed with Microsoft Office Excel 2017. Research results. The analysis of the data received has shown that gynecological anamnesis of women from the CG was reliably more frequently complicated by: late menarche 12 (30%), abnormal uterine bleeding 9 (22.5%) and dysmenorrhea 18 (45%) (p<0,05). It has been determined that the women from the CG had deliveries through natural birth canal almost twice as frequently 32 (80 %). In the MG 17 (42,5 %) conservative deliveries occurred under the condition of patients having subserous or intramural myoma nodules with the size not larger than 5 cm localized in the uterus body (p<0,05). It has been determined that pregnancies of the CG women ended with surgical delivery three times as frequently 23 (57,5 %) as in the MG 8 (20 %) (p<0,05). All cases of the cesarean section in the MG were planned in advance with regard to such variations of fibrosis as: multiple nodules, single nodules with centripetal growth, localization in the lower uterine segment or large size (5 - 16 см). It has been shown that advanced planning of the surgical deliveries with uterine fibroid and breech presentation in the MG 23 (57,5 %) does not prevent from urgent situations н 7 (30,4 %), which is complicated by the necessity of extending the volume of the surgery 3 (13 %). Issues of elective cesarean section among women from the MG did not require volume extension in any case. В свою чергу, advanced planning of conservative delivery with breech presentation in the CG 40 (100%) also does not prevent from cases of urgent surgical deliveries 8 (20 %), where the leading indication for it was deviation of labour activity 4 (50 %). Conclusions. Balanced obstetrical approach to the issue of uterine fibroid with breech presentation considering the variation of fibroids in each particular case favours preliminary determination of the optimal method of delivery for each woman, which might be effective in the cases of decreasing the indexes of maternal morbidity among such patients due to decreasing both the number of surgical deliveries and the cases of volume extension for cesarian sections.