ROLE OF MINI-INVASIVE SURGERY IN TREATMENT OF LACTATION MASTITIS

Introduction. Lactation mastitis is not a rear pathology. It is observed at every tenth parturient woman, mainly in the case of premature termination of breastfeeding. When analyzing the structure of postpartum purulent-inflammatory complications, most researchers report about high frequency lactational mastitis (in 26-67% cases). The technique of conducting wide incisions to drain the breast abscess and drug cessation of lactation was adopted to treat lactational abscess.Purpose. Specify the location for minimally invasive surgical techniques (puncture and drainage of the nidus of infection under ultrasound guidance) in the complex treatment of lactational abscesses of the mammary glands.Materials and methods. 64 parturient women suffering from verified lactation abscesses were observed. Average age of patients was 24,9±4,5 years (from 21 to 44). The research was carried out during 3 years: from 2018 to 2020. All patients were on outpatient treatment and under observation. Conservative and surgical (minimally invasive) methods of breast abscess treatment were applied. Puncture of the lactation abscess was carried out with a thick needle (18g «pink»), at the greatest distance from the areola, after expressing / feeding.Results. 41% of breast abscesses occurred during lactation up to 1 month, while in 34% of cases, the period of lactation was in the range from 1 to 3 months. In 16% of patients, an abscess formed during lactation from 3 to 7 months, in 7% of cases - from 7 to 18 months. Duration of breastfeeding was investigated at the 3rd day, 3rd week and 12th week after surgery. Breastfeeding was interrupted on women’s request. As a result we found out, that minimally invasive (puncture, drainage) surgical methods for treating breast abscesses should be prioritized at complex treatment programs for lactational mastitis.

Psychologically Traumatic Situation as a Formal Element of an Offence under Article 106 of the Criminal Code of the Russian Federation (Murder by a Mother of Her Newborn Child)

The study is aimed at finding general grounds of criminal responsibility for neonaticide (murder by a mother of her own newborn child). The formal crime signs listed in article 106 of CCRF have been analysed. The theoretical analysis is supplemented with a study of 40 criminal cases. It was concluded that the common ground for inclusion of the three formal elements of the crime (differing in a number of criteria) is the mother's limited capability to consciously and arbitrarily control her behavior while murdering her newborn child. In the first case, the main factor limiting this legally significant capability is a legislator-presumed specific psychophysical condition of the parturient woman, in the second case it is a specific emotional state caused by a psychologically traumatic event associated with pregnancy and childbirth. The third case is a mental disorder not excluding sanity. A remark about the baby-murdering mother's special emotional condition limiting her capability to be aware of her actions (and control them) has been suggested for inclusion in the text of the article. The advisability of obligatory prescription for a comprehensive forensic psychological and psychiatric examination has been substantiated when the offence is categorized under article 106 of CCRF.

Dr. Albert Green. - A Case of Post-Mortem Parturition. - (Lancet., 1895, 5 / i, p. 27). - A case of childbirth after death (with eversion of the uterus and rupture of the perineum).

A 20-year-old girl, so obese that her parents, with whom she lived, did not suppress her pregnancy, which had reached a normal term, suddenly fell ill with a headache; at night she had convulsions. The invited doctor found her in an unconscious state; seizures of convulsions were 3-4 times per hour, more tonic than clonic in nature, the tongue was bitten, the pupils were dilated. The doctor suspected poisoning with some kind of alkoloid. In the morning the patient died without being destroyed. Two women, who washed the deceased and laid her on the table, did not suppress her child's emergence; they covered her with a sheet, which there was no reason to reveal for two days, until the forensic medical examination of the corpse by Dr. Green. The last one, having removed the sheet, saw that between the legs of the deceased lay a dead newborn child, legs down, with the head at the mother's genitals, that is, with the buttocks presented; a fleshy round mass protruded from the genital organs of the deceased, which turned out to be the bottom of the uterus turned upside down and not separated from it after the house; the umbilical cord was very short. Traces of bleeding or clots were not detected. The perineum of the parturient woman was torn. Her belly was very swollen, and when she was punctured, a huge amount of gas came out of it. There were no pathological phenomena in the organs of the abdomen and chest. Strychnine was not found in the stomach and intestines sent to the chemical laboratory.

1. Puerperal Eclampsia without renal symptoms; bloodsetting; Recovery 2. Vensection in puerneral Eklampsia

Dr. Gr. was hastily summoned to a 19-year-old 1 woman in labor, who had an attack of eclamptic convulsions. The pregnancy proceeded normally, the young woman, who had been completely healthy before, walked about a mile on foot, from her to her mother, where she felt sick, she fell to the floor and began to have convulsions. Dr. Gr. found her unconscious; the child is dead, lying between the legs of the parturient woman; by cutting the umbilical cord, the patient was taken to bed; a few minutes later came the afterbirth. The eclamptic attacks did not stop. G. chloroformed the patient, poured 1 drachma chloral-hydrate per rectum: nothing helped. Then Dr. Gibson bled the mother at 12 oz. The attacks became shorter and easier, and after 6 hours the postpartum woman regained consciousness, and the next day she was out of danger.

Factors associated with obstetric interventions in public maternity hospitals

Objectives: to identify the prevalence and factors associated with obstetric interventions in parturients assisted in public maternity hospitals. Methods: a cross-sectional study with 344 puerperal women, from two public maternity hospitals, referring to childbirth by Sistema Único de Saúde (SUS) (Public Health Service System) in Londrina City, Paraná, Brazil, between January and June 2017. The medical records were the data source. The following obstetric interventions were considered: oxytocin use, artificial rupture of the membranes, instrumental childbirth and episiotomy. Multivariate Poisson regression was used to analyze associated factors, with p<5% being significant. Results: the prevalence of obstetric intervention was 55.5%, the maximum number of interventions in the same parturient woman was three. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated on maternal disease (p=0.005) and intrapartum meconium (p=0.022) independently increased, the risk of obstetric intervention, while dilation was equal to or greater than 5 cm at admission, there was a protective factor against this outcome (p=0.030). Conclusion: the prevalence of obstetric interventions was high. In the case of maternal disease and intrapartum meconium, special attention should be given to the parturient woman, in order to avoid unnecessary interventions. Thus, the maternity hospitals need to review their protocols, seeking good practices in childbirth care.

Supravaginal amputation of the septic postpartum uterus

After arbitrary childbirth and manual removal of the placenta, the parturient woman developed symptoms of sepsis.

Prof. Howard A. Kelly. Resuscitation, from impeding death due to conceoled haemorrhage, by the infusion of a liter of normal soit solution centrally into the radial artery. (American Journal of Obstetrics and diseases of women and children, August, 1894, p. 184). Death threatening the parturient woman due to latent bleeding. Revitalize by infusing 1 liter of normal saline solution into the radial artery towards the heart.

During the last ten months prof. Kelly saved the lives of six patients by injecting normal saline solution into the vessels, mainly the radial artery.

А case in obstetrics, followed for months by a daily discharge of over two quarts of a watery fuiid through the cervical canal

The patient is 34 years old. Dec 9 1890 seventh birth. Upon the exit of the placenta, extremely profuse bleeding, which brought the parturient woman to almost collapse.