Urological complications in obstetrics

Urinary tract injury is a rare but severe complication during abdominal delivery. Over the past quarter of the last century, the frequency of abdominal delivery in Russia has more than tripled due to the increase in the number of pregnant women at high risk for the development of maternal and perinatal complications. Intraoperative diagnosis of urinary tract injuries allows timely treatment with better postoperative outcomes. Given the high percentage of caesarean sections in many countries, the risk of the above complications remains high. Risk factors for urinary tract injury during cesarean section are an increase in womens average age and body mass index, high parity, the presence of adhesions, prior cesarean section, emergency cesarean section, and cesarean section in the second stage of labor. This article discusses several clinical cases on the development of urological complications in obstetrics and gynecology. Due to modern progress in the field of operative obstetrics, vesicouterine fistulas caused by obstetric causes may not occur as often as in the last century. Nevertheless, even despite this, one should not forget about elementary preventive measures in operative delivery, especially in such obstetric situations as placental ingrowth, bleeding, hematoma, and parametria.

Perioperative antibiotic prophylaxis for abdominal delivery at the regional perinatal center

Aim. To conduct a comparative pharmacoepidemiological study and assess the rational use of antibiotics in women undergoing caesarean section. Methods. A retrospective analysis of 1,025 birth histories of women after planned and emergency cesarean section was carried out with a detailed assessment of the use of antibiotics in 20072009 (523) and 20162017 (502) with an interval of 10 years for which new clinical guidelines, principles of rational pharmacotherapy and evidence-based medicine were introduced. The time of administration of the first dose, duration of administration, consumption of antibiotics were assessed. The significance of differences in relative indicators was assessed according to Pearson (2). Results. Antibiotics were prescribed to women with planned and emergency caesarean section in 100% of cases in the first period of the study (20072009) and prescribed in 98% of women with planned caesarean section and 96% with emergency caesarean section in the second period (20162017). In the first period, the first dose of antibiotic was administered: in 110 (44%) cases during surgery and 139 (56%) cases after surgery in planned caesarean section; in 139 (51%) cases during surgery and 135 (49%) cases after surgery in emergency caesarean section. In the second period, antibiotics were administered 3060 minutes before the operation in 263 (96%) cases in the planned caesarean section and 218 (95%) cases in the emergency; postoperative antibiotics were administered in 7 (2%) women in the planned caesarean section and 2 (1%) women in the emergency (p 0.05). Greater than 56 days of antibiotics were used: in 166 (67%) women in the planned operation and 166 (61%) in the emergency for the first period; in 43 (16%) women with the planned operation, and 38 (17%, p 0.05) women with an emergency for the second period. In the first period, 13 antibiotics from 8 pharmacotherapeutic groups were used and in the second period, 7 out of 5 were used. Conclusion. From 2007 to 2017, the use of antibiotics has become to comply with the implemented clinical guidelines for abdominal delivery: the duration of antibiotic use has decreased, the time of administration of the first dose and the range of antibiotics used changed.

CAESAREAN SECTION: PROBLEMS AND PROSPECTS IN THE REPUBLIC OF CRIMEA

Caesarean section (CS) is a surgical procedure performed only in critical conditions to save the life of a mother and a child. The operation should be performed only if clinically indicated. Recently, the rate of cesarean sections is growing, but the number of deaths is not decreasing. The purpose of the study is to examine the frequency of abdominal delivery in Simferopol, Simferopol Clinical Maternity Hospital No. 2, to assess the possibilities and reserves for CS reduction in the region. Methods. The authors used retrospective analysis of birth histories according to Robson classification. Results. In 2018–2019 the frequency of cesarean sections in Simferopol Clinical Maternity Hospital No. 2 increased by 3 %. It was found out that primigravida and multipara with a uterine scar in the cephalic presentation are a reserve to decrease the indicator. It may also be promising to reduce the incidence of cesarean section in pregnant women with breech presentation. Keywords: caesarean section, Robson classification, Republic of Crimea. Операция кесарева сечения является методом, проводимым только при угрожающих состояниях с целью спасения жизни матери и ребенка. Операция должна выполняться только при строгих показаниях врача. В последнее время тенденция к родоразрешению путем кесарева сечения нарастает, однако число летальных исходов не уменьшается. Цель. Определение частоты абдоминального родоразрешения в г. Симферополь на примере ГБУЗ РК «Симферопольский клинический родильный дом № 2» и оценка возможностей и резервов ее снижения в регионе. Материалы и методы. Ретроспективный анализ историй родов по классификации Робсона. Результаты. Частота кесарева сечения в ГБУЗ РК «Симферопольский клинический родильный дом № 2» в течение 2 лет возросла на 3 %. Было установлено, что резервом снижения данного показателя являются первобеременные и повторнородящие с рубцом на матке и с плодом в головном предлежании. Перспективным может быть также снижение частоты кесарева сечения у беременных с тазовым предлежанием. Ключевые слова: кесарево сечение, классификация Робсона, Республика Крым.

Analysis of global trends in caesarean section rates using the Robson classification

The rate of Cesarean section (CS) continues to rise and researchers have no clear understanding of the underlying drivers and consequences. Robson’s 10-group classification is based on simple obstetric parameters (parity, prior CS, gestational age, onset of labor, fetal presentation, and a number of fetuses), which allowed the authors to make an effective evaluation of indicators that lead to an increase in the frequency of abdominal delivery. In the context of the global increase in the frequency of abdominal delivery, further modification of the scale will allow the specialists not only to assess the frequency of CS but also to assess the levels of perinatal morbidity and mortality in the groups that make the most significant contribution to the level of CS. Global trends in the commercialization of childbirth require global approaches to reduce the level of abdominal delivery in the population.

Programmed Labor in Gestational Diabetes Mellitus as a Reserve for Reducing the Frequency of Cesarean Section

The aim of this study was to investigate the perinatal outcomes of delivery by various methods in patients with gestational diabetes mellitus (GDM). Methods and Results: The study included 403 pregnant women (gestational age of 37.0–41.0 weeks) with GDM and 68 without disorders of carbohydrate metabolism, who gave birth from the second quarter of 2018 to the third quarter of 2020 in the maternity ward of the City Clinical Hospital No. 29 named after N.E. Bauman. All patients with GDM were divided into 2 groups. Group 1 included 187 patients receiving insulin therapy; Group 2 included 216 patients receiving a well-balanced diet. The main indicators of the health status of newborns in the early neonatal period were assessed taking into account the methods of delivery: programmed labor (PL), planned cesarean section (PCS), and spontaneous delivery. The 1-minute Apgar score in newborns from mothers of Groups 1 and 2 was higher at the PL, compared with PCS. The 5-minute Apgar score in newborns from mothers of Group 2 was also statistically significantly higher at the PL, compared with planned CS. The incidence of hypoglycemia in newborns from mothers of all groups was minimal at the PL, including a statistically significant low rate in newborns from mothers of Group 1. Symptoms of neonatal CNS depression were significantly more common in newborns born by abdominal delivery from mothers with GDM. Conclusion: PL in women with GDM reduces the incidence of the main complications of the early neonatal period: hypoglycemia and symptoms of neonatal CNS depression. PL may be considered more acceptable than abdominal delivery for women with GDM.

Caesarean section ‒ global trends (literature review)

Caesarean section (CS) is the most commonly performed surgical operation in the world. Since its introduction in obstetric practice, caesarean section rates have continuously increased in both developed and developing countries. A substantial proportion of this increment was due to unnecessary operations attributable to nonevidencebased indications, professional convenience, maternal request, and overmedicalisation of childbirth. The review examines current data on operative abdominal delivery in the world.

Locked twins—remote from term: a case report

Background Locked twins is a rare and hazardous obstetric complication, which occurs in approximately 1:100 twin pregnancies. One of the known etiologic factors for locked twins is size of the twins. We report a case of chin-to-chin locked twins that occurred at gestational age of 30 weeks pus 6 days. Case summary A 27 years-old primigravida Oromo mother presented with a history of pushing down pain and passage of liquor of 6 hours duration at gestational age of 30 weeks plus 6 days. With a diagnosis of twin pregnancy (first twin non-vertex), abdominal delivery was decided in latent first stage of labor but mother refused caesarian delivery and she was allowed to labor with the hope of achieving a vaginal delivery. In second stage, interlocking twin was encountered and a low vertical cesarean section was done to effect delivery of twins without the need to decapitate the first twin. Conclusion Locked twin is a rare obstetric complication. Whenever it is encountered, successful delivery can be achieved without the need to have decapitation of the first twin during caesarian section.

Features of using accelerated rehabilitation protocols in obstetrics: literature review

Accelerated postoperative rehabilitation and reduction of hospitalization periods and faster recovery are modern principles of surgical treatment that are widely implemented in practical healthcare. This approach is especially relevant in obstetrics and gynecology, where the share of abdominal delivery reaches up to 80% in some countries of the world. The advantages of accelerated rehabilitation protocols to reduce the number of days of hospital stay, reduce postoperative pain, and need for analgesia, rapid recovery of bowel function, fewer complications, increased patient satisfaction. This approach has direct economic benefits for health care institutions and is carried out in the interests of the child. The article is a review of the available literature on accelerated rehabilitation and recovery of patients in the world practice, as well as the experience of implementation in some healthcare institutions of the Russian Federation.