Number Of Serious Complications Research Articles

Epidural anesthesia is no longer the standard of care in abdominal surgery with ERAS. What are the alternatives?

Epidural anesthesia has been considered the gold standard for perioperative analgesia, but the implementation of enhanced recovery after surgery (ERAS) protocols and a shift from open to laparoscopic surgery have diminished the advantage of epidural anesthesia. The authors summarize data from two newer meta-analyses and discuss the consequences for the role of epidural anesthesia (EA) in the perioperative setting. These meta-analyses enabled to distinguish between pre- and post-ERAS outcomes. Endpoints related to open and laparoscopic abdominal surgery were retrieved. General data, also applicable on abdominal surgery, were included. Data on other types of surgery were ignored. Two meta-analyses met the subject and inclusion criteria of the search. They demonstrate no difference between epidural analgesia and the control for most investigated endpoints. Analgesia employing epidural techniques is often not clinically superior to its alternatives; is associated with a small but relevant number of serious complications; and has a relatively high failure rate. Data show that the distinction between pre-ERAS and ERAS is essential for understanding the role of EA in intestinal surgery. Since ERAS was introduced, the advantages of epidural anesthesia vanished while the incidence of serious neurological complications is higher than previously thought. The authors conclude that epidural anesthesia in abdominal surgery has become less preferred and is limited to patients and types of surgery known to be accompanied with difficult pain management. This requires the use of other methods for analgesia, such as intravenous ketamine, peripheral nerve blocks, continuous wound infiltration, intrathecal morphine, and intravenous, and non-invasive PCA.

Association of number and type of serious complications with failure to rescue in children undergoing surgery: A NSQIP-Pediatric analysis

BackgroundFailure to rescue (FTR) represents death after a serious complication. This study aims to determine the FTR rate in a pediatric surgical population, and if number (1 or 2+) and type of serious complications are associated with FTR. MethodsA secondary analysis was performed using the National Surgical Quality Improvement Program Pediatric database from 2012 to 2016. Primary and secondary exposures of interest were number (1 or 2+) and type of serious complications, respectively. Propensity score analysis adjusted for baseline covariates. Primary outcome was FTR. ResultsOf 36,167 children with ≥1 serious complication, there were 851 deaths resulting in a FTR rate of 2.4%. Having 2+ serious complications was associated with higher adjusted odds of FTR (OR 1.77, 95% CI 1.52–2.08, p < 0.0001). Among those who had one complication, the type of serious complication was significantly associated with FTR. When type of initial serious complication was adjusted, number of serious complications continued to be strongly associated with FTR (OR 2.00, 95% CI 1.67–2.38, p < 0.0001). ConclusionsFTR rate within a large, diverse, multi-specialty pediatric surgical population was 2.4%. Both number and type of postoperative complications were associated with FTR. These findings may facilitate early recognition of high-risk patients and identify quality targets for pediatric surgical centers. Level of EvidenceRetrospective study (secondary analysis), Level II.

Implementation of a chest drain bundle at Stepping Hill Hospital has improved the quality of chest drain insertion and patient safety

Intercostal chest drains are required in a number of clinical settings. Despite the move towards Seldinger chest drains, concerns have remained about patient safety and the number of serious complications seen.1 The British Thoracic Society released guidance in 2010 relating to chest drain insertion and management.2 Chest-drain-related incidents are under-reported, so we undertook a project to monitor the quality of our chest drain insertion and whether the introduction of a bundle could improve outcomes. To investigate the effect of introducing a trust-wide chest drain …

Assessment of Hyperurcemia in Patient with End Stage Chronic Kidney Disease

Chronic kidney disease (CKD) has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. Progression of CKD is associated with a number of serious complications including increased incidence of cardiovascular disease, hyperlipidemia, anemia and metabolic bone disease. Hyperurcemia may be a major contributor to the development of progression of chronic kidney disease (CKD). Although there is no clear cutoff uric acid (UA) value associated to the risk for kidney damage, it appears to be an increased risk as UA rises.

Perioperative Complications and Prognosis of Curative Surgical Resection for Spinal Metastases in Elderly Patients

The purpose of this study was to evaluate perioperative complications and prognosis associated with curative surgical resection, such as total en bloc spondylectomy, for spinal metastases in elderly patients. We retrospectively reviewed 103 consecutive patients who underwent curative surgery between 2010 and 2017 and divided them into group 1 (n= 27, age <50 years), group 2 (n= 47, age ≥50 and <65 years), and group 3 (n= 29, age ≥65 years). Perioperative complication rate and overall survival (OS) after surgery was evaluated. A total of 129 perioperative complications were observed in 76 of 112 surgeries. Among the 3 groups, the total number of complications per person was the highest in group 3, although the difference was not statistically significant. The total number of serious complications per person was the highest in group 3, which was statistically significant. (0.23 vs. 0.51 vs. 0.90; P<0.05). No significant difference in OS was observed between the groups. In group 3, a significant difference in OS was found between subgroups 1 (renal cell, thyroid, and breast cancer metastasis) and 2 (other primary tumors) (P < 0.01). In group 3, 24 patients (83%) either maintained or had regained their ambulatory capacity at the final follow-up. Elderly patients who underwent curative surgery had significantly more frequent serious postoperative complications than nonelderly patients. Even in patients with advanced age, curative surgical resection can provide favorable prognosis and local control, especially in those with spinal metastases of renal cell and thyroid cancer.

Arthroscopic Coracoclavicular Ligament Reconstruction of Chronic Acromioclavicular Dislocations Using Autogenous Semitendinosus Graft: A Two-Year Follow-up Study of 58 Patients

PurposeTo determine the results of operatively treated chronic acromioclavicular (AC) joint dislocations after 2-year follow-up.MethodsFifty-eight patients with chronic acromioclavicular separations underwent arthroscopic coracoclavicular ligament reconstructions using semitendinosus autografts. Constant and Simple Shoulder Test scores were determined before and 2 years after surgery as a part of standard clinical practice. General patient satisfaction with the outcome (poor, fair, or excellent) also was assessed. In addition, for purposes of routine clinical follow-up, the coracoclavicular distance was measured from the inferior cortex of the clavicle to the superior cortex of the coracoid using anteroposterior radiographs taken 2 years after surgery. The results were compared with postoperative radiographs and changes in the distance were recorded. The clavicular drill hole was similarly measured 2 years after surgery to detect possible tunnel widening.ResultsThe mean preoperative Constant score increased from a preoperative mean of 52.6 ± 16.5 to 94.7 ± 7.9 at 2 years postoperatively (P = .000). The Simple Shoulder Test score increased from a preoperative mean of 7.7 ± 1.64 to 11.8 ± 0.7 (P = .000). The mean coracoclavicular distance increased from 10.5 ± 3.4 to 12.4 ± 3.9 mm (P = .009). The diameter of the clavicular drill hole increased from 6.0 mm to a mean of 8.4 mm. Two coracoid fractures were observed, but no clavicular fractures. One patient experienced a deep infection, leading to total reconstruction failure, and 2 patients had superficial postoperative infections. Forty-five patients (85%) reported excellent subjective outcomes, and 8 (15%) reported a fair outcome.ConclusionsThe outcomes of this series of coracoclavicular ligament reconstruction were favorable and the number of serious complications was small. However, clavicular wound issues were a significant problem. Coracoclavicular ligament reconstruction is a challenging procedure, but satisfactory results can be achieved with careful patient selection and good technique.Level of EvidenceLevel IV, therapeutic case series

Study of Complications in Patients Using Removable Dentures Over Different Periods

The topicality of the problem is related to the ever-increasing volumes of provision of prosthodontic assistance to the patients with removable dentures. During the dental examination we’ve noted 300 patients, who used removable dentures, the increased number of complications because of these constructions’ use. In particular, there is a growing number of patients who aren’t using the already made removable dentures. A significant percentage of patients don’t know or don’t fully care properly for the existing constructions and the oral cavity itself. This leads to a number of serious complications. We consider perspective the identification of opportunities to reduce the number of complications and extend the period of the use of removable denture structures by improvement the techniques for selecting denture base materials depending on the microbiological status of the oral cavity.

The Combined Role of Herbal Therapy in the Prevention of Urinary Tract Infections During Prostate Biopsy

Prostate biopsy is a routine method for diagnosing prostate cancer. However, there are a number of serious complications associated with this procedure, and especially development of infection.The objective. Evaluation of the effectiveness of complex herbal therapy in the prevention of infectious complications in patients exposed to prostate biopsy.Materials and methods. The study included 40 patients aged 48 to 69 years who underwent prostate biopsy. Patients with chronic prostatitis (category 4 NIH) were divided into two groups. Patients in the comparison group limited to standard antibiotic therapy, and the patients of the main group additionally received Canephron® N. The efficacy of the therapy was evaluated at 1, 2 and 6 months after the start of treatment by the dynamics of leukocyte count in prostate secretion and bacterial contamination, prostate– specific atigen (PSA) level, questionnaire data, ultrasound and urodynamic survey methods.Results. The level of PSA compared to baseline data, decreased by 56.9 % in the comparison group and by 67.6 % in the main group (p&lt;0.05). A clinically significant bacterial titer and an increase in the number of leukocytes more than10 in sight, were registered in the comparison group in two times more often, than in patients of the main group.Conclusion. The results of the study make it possible to recommend for patients with chronic prostatitis of category 4 NIH the prescription of Canephron N.

Anterior cruciate ligament reconstruction-related patient injuries: a nationwide registry study in Finland

Background and purpose — Treatment outcomes of anterior cruciate ligament (ACL) injuries are generally good, but complications after ACL reconstruction (ACLR) can result in long-lasting problems. Patient injury claims usually fall on the more severe end of the complication spectrum. They are important to investigate because they may reveal the root causes of adverse events, which are often similar regardless of the complication’s severity. Therefore, we analyzed ACL-related patient injuries in Finland, the reasons for these claims, causes of complications, and grounds for compensation.Patients and methods — We analyzed all claims filed at the Patient Insurance Centre (PIC) between 2005 and 2013 in which the suspected patient injury occurred between 2005 and 2010. This study also reviewed all original patient records and available imaging studies. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO).Results — There were 248 patient injury claims, and 100 of these were compensated. Compensated claims were divided into 4 main categories: skill-based errors (n = 46), infections (n = 34), knowledge-based errors (n = 6), and others (n = 14). Of the compensated skill-based errors, 34 involved graft malposition, 26 of them involved the femoral-side tunnel. All compensated infections were deep surgical site infections (DSSI).Interpretation — This is the first nationwide study of patient injuries concerning ACLRs in Finland. The most common reasons for compensation were DSSI and malposition of the drill tunnel. Therefore, it would be possible to decrease the number of serious complications by concentrating on infection prevention and optimal surgical technique.

Gastroesophageal reflux disease: a modern view on the problem

The importance of the GERD problem is determined not only by the increase in its prevalence, but also its clinical significance, in particular the possibility of the existence of so-called extra-extravascular manifestations of the disease, as well as the inadequate effectiveness of existing treatments. The goal of the work. To systematize modern theories on etiology, pathogenesis and diagnostics of GERD. GERD is the most common gastroenterological pathology. The incidence in the world reaches 50% of the population, there are no definitive data on prevalence. However, this pathology has a number of serious complications: bleeding, Barrett esophagus, adenocarcinoma of the esophagus. GERD is a multifactorial illness. The main links are the violation of antireflux mechanisms and damage to the resistance of the mucous membrane of the esophagus. All diagnostic methods are invasive, with different specificity and sensitivity. Conclusions. A detailed study of the sequence of pathogenetic mechanisms of the GERD will allow the development of early diagnostic markers, to monitor the effectiveness of pharmacotherapy and to predict endoscopic changes in the esophagus mucosa. None of the separate diagnostic techniques can provide unconditional confirmation or rejection of the presence of GERD. In addition, some of them are expensive and cause the patient's refusal due to the discomfort of the examination procedure.

The relevance of the early terms of the formation of percutaneous endoscopic gastrostomy after a stroke complicated by severe neurogenic oropharyngeal dysphagia (review of the literature)

Neurogenic oropharyngeal dysphagia (NOD) was a frequent complication after a stroke, determining the further prognosis and quality of life, causing a number of serious complications. Patients with severe NOD was recommended enteral feeding through the nasogastric tube (NGT) with the subsequent formation of a percutaneous endoscopic gastrostomy (PEG). Prolonged use of NGT had its own complications – sinusitis, gastroesophageal reflux, aspiration pneumonia, etc., and therefore it should be limited in time. In various recommendations, the length of terms before the formation of the PEG remained controversial. The analysis of modern tactics of PEG in patients after severely developed NOD was performed on the basis of literature data.

Deep neck space abscesses in children: 15 years of experience in a children's ENT referral unit

IntroductionDeep neck space abscesses in infants are clinical entities of great importance due to their severity and possible complications. The aim of the study is to review our experience in the diagnostic and therapeutic management of deep neck space abscesses, and compare it with published literature. Material and methodsRetrospective study was carried out on all patients diagnosed and treated for deep neck space abscesses over a 15-year period (2002–2016), including an analysis of the demographic, clinical, diagnostic and therapeutic characteristics. ResultsA total of 72 cases were diagnosed. An increase was observed in their incidence in recent years. The most frequent locations were peri-tonsillar (30.6%), followed by swollen lymph nodes (18.1%), parapharyngeal (16.7%), and retropharyngeal (16.7%). The least frequent were submandibular abscesses (12.5%) and parotid abscesses (5.6%). The distribution was different according to age (P<.001). The most frequent clinical symptom was fever (70.8%), followed by odynophagia (55.56%). The most used imaging tests were CT (50.7%) and ultrasound (28.2%). The treatment used was pharmacological in 11.1%, all of them abscessed swollen lymph nodes of less than 1.5cm in maximum size. The other 88.9% underwent surgery. There was recurrence in 12.5% of the cases. ConclusionsThe performance of tonsillectomy and/or early cervicotomy in abscesses larger than 2cm or lesions of deep location decreases the number of serious complications and does not have recurrences. When using more conservative surgery, there were 12.5% of recurrences.

Результаты применения шестирукавного сетчатого импланта OPUR при лечении передне-апикального пролапса: наш опыт

At present, mesh surgery goes through difficult times related to the imperfectness of the existing mesh implants and the methods of their placement and, accordingly, to quite a number of serious complications and legal actions associated with these circumstances. The urogynaecological community meets the appearance of new mesh technologies with «a great deal of critical attention». Objective. To assess the effectiveness of a six-arm mesh implant OPUR for management of anterior apical prolapse. Patients and methods. From December 2013 to December 2019, 150 patients with anterior apical prolapse were treated. Their age varied from 34 to 78 years. The mean BMI was ~29.0. The exclusion criteria were: rectocele grade II and higher according to POP-Q; a history of hysterectomy; diseases of the uterus requiring hysterectomy; previous reconstructive surgeries on the pelvic floor. Management of urogenital prolapse was performed using a six-arm mesh implant OPUR (Abiss). During gynaecological examination all women underwent an imitation test to predict post-operative stress urinary incontinence (de novo stress urinary incontinence). The mean follow-up period was ~39 months (6–60 months). Results. The effectiveness of management of anterior apical prolapse was 99.3% in treatment of cystocele and 98% in case of hysteroptosis. 14 intra- and post-operative complications were obtained. Except for excision of vaginal membrane erosion in 2 cases (class IIIb) and injury to the urinary bladder, repaired intraoperatively (class IIIb), all complications were classified according to the Clavien-Dindo system as grade I complications. Conclusion. In our study, we have demonstrated a high effectiveness of a six-arm mesh implant in management of anterior apical prolapse with a minimal risk of complications. The method displays good anatomical outcomes in both near and long-term perspectives. Key words: mesh surgery, mesh implant, pelvic organ prolapse, cystocele, hysteroptosis, transvaginal surgery

On the pathogenesis of thromboses in antiphospholipid syndrome

Antiphospholipid antibodies (AFA) are a heterogeneous group of autoantibodies produced humans under various pathological conditions; the main one of those is the antiphospholipid syndrome. AFA cause a number of serious complications, such as thrombosis, pathology of pregnancy and childbirth, multisystem damage to organs and tissues. Thrombosis caused by AFA can develop both in the venous and arterial circulation, and are characterized by high mortality and morbidity rates.

The Decision for TIPS for Refractory Ascites: How to Weigh the Social Aspects Involved in Undocumented Patientsʼ Care

Transjugular intrahepatic portosystemic shunt (TIPS) insertion is associated with a number of serious complications and thus necessitates a careful consideration of the risks and benefits to the procedure individualized to each patient. Such assessments usually include relevant clinical characteristics of a patient, but the social dynamics may need to be considered as well. We present the case of an undocumented 45—year—old male with a history of former alcohol abuse and alcoholic cirrhosis (MELD 16, Child—Pugh Class B) who presented with symptomatic massive ascites. One month prior to the admission, the patient's diuresis regimen had been increased to maximum intensity. However, the patient upon admission was unsure whether he had been taking the correctly increased regimen or the prior one. After multiple large—volume paracenteses, the patient expressed that after discharge he would return to his native country in order to be with his family given his relatively poor prognosis. Furthermore, he requested for any definitive intervention that would decrease the likelihood of further episodes of symptomatic ascites, as he did not trust the medical care in his home country. TIPS procedure was considered in order to hopefully provide the patient a resolution to his refractory ascites, though it was unclear whether the patient had truly failed a maximized diuretic regimen. Furthermore, the patient's urinary sodium excretion suggested diuretic sensitivity. Upon suggestion of an appropriate diuretic trial after discharge with subsequent follow up for TIPS consideration as an outpatient, the patient responded that his plan was to leave for his home country immediately after discharge in order to not waste any of his remaining time left with his family. The decision regarding TIPS as an inpatient given the social circumstances despite the ambiguity regarding the patient meeting clinical criteria was deliberated extensively by all providers involved in the patient's medical care. Ultimately, the decision was made to avoid TIPS as an inpatient based on the principle to avoid possibly causing harm to the patient from a complication of a procedure that may not have been medically indicated. Our case demonstrates an ethical dilemma with regard to how strictly medical professionals should abide by criteria indicating when a procedure is necessary. While other providers may disagree, we felt the principle of “Do no harm” prevailed in our estimation of the patient's care.

THE SUPERINFECTION THAT’S A REAL HEADACHE

SESSION TITLE: Critical Care 1 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Legionnaires’ disease serves as one of the most ubiquitous causes of community-acquired pneumonia. We are reporting a rare case of influenza with a superinfection of Legionnaires disease presenting with altered mental status due to severe hyponatremia. CASE PRESENTATION: A 60-year-old woman with no significant medical history was brought to the ER by her sister after she was found on the ground. According to her sister, the patient had a right facial droop with dried blood in her nares and sub-conjunctival hemorrhage as well as an “unusual posturing” of her hands and feet. Prior to the event, she had been complaining of nausea and vomiting for the past two days for which she had been taking Alka-Seltzer and herbal teas. On physical examination, she remained unconscious with bilateral conjunctival swelling and injection but no nuchal rigidity or apparent head injury. Temperature was 99.7 F with heart rate of 70 bpm, blood pressure was elevated to 221/105 mmHg. She was intubated with subsequent improvement in BP. The initial laboratory results revealed hyponatremia with sodium of 109 mEq/L and elevated creatinine kinase level of 11108. Urine toxicology report was negative. CT imaging of head demonstrated cerebral edema with loss of the gray and white matter significant for global ischemia. After admission to the ICU for management of hyponatremia and cerebral edema, she was found to be influenza and legionella positive. She completed a course of Tamiflu and Levaquin and sodium was slowly corrected to 134mEq/L. She was extubated on hospital day 3, by day 6 she had complete restoration of mental status and strength and was discharged home. DISCUSSION: While the most common superinfections with influenza are S. pneumoniae, H. influenzae, and S. aureus, Legionella has been associated with influenza virus (1). There exists no particular set of clinical features that should raise suspicion for the disease as the presentations may differ. Legionella etiology of community acquired pneumonia serves as a strong predictor for low sodium level, independent of disease severity (2). Although previous studies suggested antidiuretic hormone-independent mechanisms such as direct renal effects of cytokines and toxins as the culprit, the mechanism still remains unknown. (3). However, since hyponatremia can cause a number of serious complications, such as coma and death, there still needs to be a careful management of those patients presenting as symptomatic hyponatremia. When dealt with the right management with correction of sodium level and appropriate antibiotics in a timely manner, one may expect a dramatic improvement in patients’ physical and mental status. CONCLUSIONS: Even though the extent of hyponatremia in patients with Legionella pneumonia may not correlate with the severity of the disease, hyponatremia in itself can lead to dangerous outcomes and suspicion for legionella infection should be high. Reference #1: Morris DE, Cleary DW, Clarke SC. Secondary Bacterial Infections Associated with Influenza Pandemics. Frontiers in Microbiology. 2017;8:1041. https://doi.org/10.3389/fmicb.2017.01041. Reference #2: Yu, Victor L. Legionnaires' Disease: Importance of High Index of Suspicion in Patients in the ICU with Community-Acquired Pneumonia. CHEST. 2014;145:2. DOI: https://doi.org/10.1378/chest.13-2170 Reference #3: Schuetz P, Haubitz S, Christ-Crain M, Albrich WC, Zimmerli W, Mueller B. Hyponatremia and anti-diuretic hormone in Legionnaires’ disease. BMC Infectious Diseases. 2013;13:585. https://doi.org/10.1186/1471-2334-13-585. DISCLOSURES: No relevant relationships by Erica Altschul, source=Web Response No relevant relationships by Cyra-Yoonsun Kang, source=Web Response

Complications of Colonoscopy and its Management: A Single Gastroenterologist Experience.

BACKGROUND Colonoscopy is a widely used procedure and although is generally safe, it could have both gastrointestinal and non-gastrointestinal complications. The aim of this report is to assess the major complications of colonoscopies performed by one expert gastroenterologist and their management in Tehran Iran. METHODS We have recoded the rates of adverse events and their management in all the colonoscopies performed by a single expert gastroenterologist during 23 years (1994-2017). Demographic factors including age, race, and sex, and colonoscopy findings and patients’ comorbidities were recorded. RESULTS During 23 years, 9012 colonoscopies and about 1700 polypectomies were performed. The number of serious complications was six (0.07%). Colonic perforation occurred in five patients (0.06%); three of whom had undergone polypectomies. All cases of colonic perforation were managed by surgery and all were discharged with no complications. One patient suffered from cardiac arrest just after colonoscopy in the recovery room and died 20 days after colonoscopy (0.01%). CONCLUSION Although the rate of adverse events after colonoscopy was low, it is still an important concern in developing screening recommendations in low and middle-income countries.

Retrospective single-center analysis of the reasons and serious complications of peritoneal-related peritonitis in patients with end-stage renal disease undergoing peritoneal dialysis treatment

Abstract Introduction. Peritonitis is still a serious complication of peritoneal dialysis (PD). Consequences of peritonitis can be severe. The most severe are peritoneal dialysis discontinuation and patient’s death. In majority, peritonitis is bacterial in the origin. Mainly there is a gram-positive infection, less commonly gram-negative one. Some peritonitis are culture-negative, because of former antibiotics use. In minority, fungal, tuberculous or even viral peritonitis are observed. Aim. The aim of the present study is to analyze the number, origin and serious complications of peritoneal-related peritonitis cases found in our PD center. Material and methods. We performed a retrospective five-years evaluation of medical records. The total number of peritonitis episodes was 56 cases, underwent by 30 adult patients on chronic peritoneal dialysis. Peritonitis was diagnosed according to ISPD recommendations. Causes and serious complications of peritoneal-related peritonitis were analyzed in every single year. Etiology of peritonitis was classified on the basis of the result of effluent dialysate culture as: gram-positive, gram-negative and culture negative. Peritoneal dialysis discontinuation or patient’s death were defined as serious complications. Results. Among 56 cases of peritoneal-related peritonitis 44.6% were gram-positive, 26.8% gram-negative and 28.6% culture-negative. No fungal or tuberculosis peritonitis were found. Because of the peritonitis complications in the evaluated period, six patients discontinued peritoneal dialysis and were switched to hemodialysis (20%), two others died (6.7%). Conclusion. The further improvement in peritonitis’ causes identification and treatment is needed in order to reduce number of serious complications in our medical center.

OPTIMIZATION OF TACTICS OF MANAGEMENT OF MULTIPLE PREGNANCY AND LABOR

A thorough analysis of the course of labor and perinatal outcomes was conducted in pregnant twins. It is proved that multiple pregnancy is a factor of high risk of perinatal complications. The features of the process of neonatal adaptation in twins are studied depending on the tactics of delivery. Goal: to improve perinatal outcomes in women with multiple pregnancies by optimizing the management of pregnancy.Material and methods. Examined 68 pregnant women with twins after IVF, who made up the I group of subjects, 62 pregnant women with spontaneous twins - group II, and 38 women with self-singleton pregnancy who entered the control group. Pregnant Groups I and II, depending on the treatment prescribed, were divided into two subgroups: IА (36 pregnant women) and IIA (32 pregnant women) received a standard amount of treatment and prophylactic measures. Subgroups IB (32 pregnant women) and IIB (30 pregnant women) received natural micronized progesterone (200 mg 3 times a day) in addition to standard treatment and prophylactic measures. All pregnant women underwent a complete clinical and laboratory examination using ultrasound, Doppler, and cardiotocography (CTG), and a biophysical profile of the fetus. The analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups were carried out. In the neonatal period, neurosonography was performed, a part of the newborns were followed by psychomotor development in the first six months of life. The obtained results were statistically processed using standard packages of applied statistical analysis (Statistic 6.0 for Windows, Statgraphics v. 7.0).Results. The results of pregnancy analysis in patients with IVF revealed a number of serious complications during pregnancy and childbirth: the threat of premature birth (66.2%), placental dysfunction (48.5%), iron deficiency anemia (51.5%), preeclampsia (52, 9%), premature rupture of amniotic membranes (17.6%), weakness of labor (27.9%), and a high incidence of operative delivery (30.9%). Against the backdrop of hormonal support, a decrease in the frequency of very early premature births in the first group was 1.6 times, early premature births by 1.5 times and an increase in the frequency of late premature births by 1.4 times, which is a favorable prognostic factor for reducing perinatal losses. Among the main methods of delivery, mention should be made of the high rate of cesarean section in the I A subgroup (55.6%) and the IIA subgroup (46.9%), each of which was significantly higher than the control group (10.5%) ( p &lt;0.05). Almost with the same frequency cesarean section was observed in women with independent multiplicity. Premature and deep morphofunctional immaturity were inherent in children from premature births, which significantly influenced the Apgar score, which was lower in the first group than in group II and control group (p &lt;0.05).Conclusions. A differentiated approach to the preparation and management of labor, careful observation of patients and dynamic monitoring of the fetus state allows to reduce the frequency of postnatal complications, contributing to the reduction of perinatal morbidity and mortality.

FEATURES OF SHELL STRUCTURE OF OIL GLOBULE IN WATER-OIL EMULSION

Background The development of oil fields exploited for a long time is characterized by high water cut of oil, which causes a number of serious complications, such as the formation of inorganic salts on the inner surface of oil pipelines, high corrosion activity of the extracted products, and intensive emulsion formation. These complications increase the accident rate, accompanied by environmental and material damage. Attempts to reduce the corrosion rate of pipelines by applying inhibitor protection lead to surfactants concentration increase in the aqueous phase. Removal of salt deposits from tubing and oil pipelines leads to an increase in the mass of mechanical impurities present in the suspended state in the water-oil stream. As a result, electrostatic stabilization of the oil globules in water of the surfactant and the mechanical stabilization of individual oil globules in water by suspended particles occur. Aims and Objectives To examine features of shell structure of oil globule in water-oil emulsion. Results The results of the analysis of literature sources showed that the stability of the emulsions is ensured by the formation of energetically stable globules, the shell of which consists of surfactants, resins and solids, made by hydrogen bonds and van der Waals forces. In the shell of globules, layer of resins and surfactants made by hydrogen bonds and oriented by mutual polarization is formed. In case of emulsion type «oil in water» formation hydrophilic ligand mole-molecules emerge on the shell surface. As the surfaces of globules have like charges, globules are repelling from each other, and electrostatic stabilization of emulsions occurs. Emulsions stability increases in course of time due to globules crushing and aging. For this emulsions stabilization mechanism there is a need of development of new methods of breaking based on the induced in the flow of emulsion directed electric field that can change the orientation of the surfactant molecules and resins in the outer shell of the globules, reduce the surface tension, the magnitude of the charge on the surface and, thus, ensure the fusion of globules colliding in a turbulent flow.