Maternal mortality: structure and solutions to the problem

Maternal mortality is the most important indicator of womens health, but its level is still high. In 2018, 146 cases of maternal death were registered in the Russian Federation. Its main causes were extragenital diseases, bleeding, preeclampsia and eclampsia, amniotic fluid embolism, clinical narrow pelvis, and unsafe abortion. The aim of this study was to assess the structure of maternal mortality in recent years and to evaluate possible ways to reduce it. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on the maternal mortality issue. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, and Cochrane Library from the creation until July 2021. The measures adopted so far do not allow for counting on a further decrease in maternal mortality rate, therefore the coming decade requires the introduction of artificial intelligence technologies.

Robot-assisted resection of rectal duplication cysts: A case report

Rectal duplication cysts are extremely rare and account for only 4% of all gastrointestinal duplication cysts. They may become difficult for removal in the case of a large tumor in a narrow pelvis. Herein, we report a case of rectal duplication cysts excision via robotic-assisted laparoscopic surgery and its utility.

Effect of fallopian tube ligation on tubal patency

Among the methods of surgical sterilization of women, ligation of the fallopian tubes is one of the oldest. First used by Lungren in 1880 in a woman with a narrow pelvis, this method, due to its lightness, speed and absence of significant trauma, attracted the attention of gynecologists and quickly found a wide range of applications. Soon, however, reports began to appear in the literature about the unreliability of this sterilization method (Fritsch, Arendt, Nrnberger, Pisemsky, etc.).

Ultrasound investigation in pregnant women with diabetes mellitus

Introduction. Ultrasound (US) has been used in obstetrics for more than 30 years and is considered to be reliable, simple, quick in results, painless and cheap method. The aim: to optimize the use of US in childbirth in pregnant women with diabetes and determine the outcome of childbirth, taking into account the condition of the fetus and newborn. Materials and methods. 52 pregnant women, among them 32 with diabetes mellitus (pre-gestational diabetes was in 20 persons and 12 persons had gestational diabetes) have been examined. The average age of pregnant women in the main group was 29.8 ± 5.4 years, in the control group - 25.7 ± 4.3 years. All women in the main and control groups were primiparous. The gestation period in the main group was 39.1 ± 0.5 weeks [38.0; 39.6], in the control group - 39.5 ± 0.7 [38.4; 40.5] weeks. Clinical-laboratory and instrumental examinations were made. Control group consisted of 20 physiologically pregnant women. To determine the condition and size of the fetus and its progress in labor, immediately at the end of the first and during the second staage of labor, transabdominal and transperineal US and Doppler examination were performed with device HD 11 XE Phillips (USA). Results. Pregnant women with diabetes are more likely to have a pathological second stage of labors due to macrosomia and problems with the birth of the fetus, as evidenced by the lack of increased angle of progress and decreased head-perineal distance. The data obtained indicate the prospects of using ultrasound in childbirth as an objective non-invasive method for predicting the likelihood of vaginal birth, which will reduce operative delivery and perinatal pathology. Conclusions. The use of ultrasound in childbirth in women with diabetes and diabetic fetopathy can determine the possibility of complications in the promotion of the fetus, including clinical narrow pelvis, shoulder dystocia, the occurrence of distress, as evidenced by the Apgar scale and CLS. Intraparietal ultrasound helps to guide the plan of childbirth, reduce the frequency of cesarean delivery, perinatal morbidity and mortality, and birth trauma.

Current aspects of the progress of labor in healthy women according to the data of the retrospective analysis

Purpose of the work – to study the current aspects of the course of labor in healthy women using retrospective indicators.Material and methods. To study this topic, an analysis of 1.078 births of women who were born on the basis of the maternity ward for pregnant women with obstetric pathology of the State Institution «Institute of Pediatrics,Obstetrics and Gynecology named after acad. O.M. Lukyanova National Academy of Medical Sciences of Ukraine». It was found that of all births, the proportion of first-borns was 602 (55.8 %) women, of whom 451 (41.8 %) were pregnant, and only 86 (8 %) were healthy pregnant women, which we will study in the future.Results. It was found that among 86 births, the frequency of physiological births was 64 %, of which in 47.7 % of cases childbirth was complicated, and pathological – 36 %. The most common complications during childbirth were: premature rupture of membranes (PRPO), episio- and perineotomy, trauma to the birth canal. The causes of pathological childbirth in the examined women were: abnormalities of labor, fetal distress, defect of manure and membranes, clinically narrow pelvis, malposition of the fetus and early postpartum hemorrhage. All children were born alive. It should be noted that all births, where the Apgar score was ≤ 6 points, had no partner support, and the women themselves did not undergo any preparation for childbirth. Conclusions. According to our data, in almost healthy women who gave birth for the first time and had no perinatal loss in the anamnesis, did not undergo prenatal training and did not have partner support during childbirth, the number of complications during childbirth is increasing. Therefore, this group of healthy pregnant women needs more detailed study and analysis, development of prenatal training algorithms to improve perinatal indicators.

Obstetric palsy n. реrоnеі. Whitman (Surgery, Gynecology and Obstetrics, Chicago, 1922)

In discussing this rare phenomenon, the author considers it the result of compression of the intrapelvic segment of the sciatic nerve by a large fetal head in a narrow pelvis or traumatization with forceps.

Caesar section

Schiftmann (Zentr. F. G., 1921, No. 45) divides modern indications for abdominal caesar section into 4 groups: 1) the absolute impossibility of childbirth with a narrow pelvis at C, ѵ. 6 site, and below (in the interests of the mother); 2) in order to exclude the birth act in the interests of the mother and the fetus with a narrow pelvis, with tumors, heart disease, pl. praevia, with interpositio uteri gravidi, varices, with fistulas, saggy stomach, etc.; 3) in order to quickly terminate pregnancy (only in the interests of the mother) with nephritis, eclampsia, premature placental abruption, encephalitis, ileus'e, fever, etc.; 4) to eliminate the alleged danger to the fetus (prophylactic indications).

Risk Factors of Sectio Caesarea Delivery at Djafar Harun Hospital

The number of mothers giving birth with sectio caesarae delivery at BLUD R.S H.M Djafar Harun North Kolaka in 2015 was 254 people, then increased in 2016 to 521 people. The purpose of this study was to analyze the risk factors for the incidence of Sectio Caesarea delivery at H.M Djafar Harun Hospital, North Kolaka. This type of research is an analytic observational study with a case-control study approach. The study population was 68 with a sample of 136 people using the Accidental Sampling Technique. Data analysis using the Odds Ratio test. The results of the risk analysis based on narrow pelvic factors showed the value of OR= 9,681; LL= 2,728; UL= 34,355, and then placenta previa factor showed the value of OR= 6,484; LL= 0,759; UL= 55,385. In conclusion, narrow pelvis is a strong risk factor and placenta previa is not a strong risk factor for Sectio Caesarea delivery. It is hoped that the hospital will seek to identify high-risk pregnancies, complications or pregnancy abnormalities so that they can be detected early so that they are able to more optimally handle complications during childbirth.

TaTME: Present and Future Perspectives?

Transanal total mesorectal excision (TaTME) is a new procedure developed to overcome the specific difficulties posed by rectal surgery, especially in narrow pelvis, male, and obese patients, and can be used in benign and malignant pathologies. The advantages are especially important in rectal cancer, as they could potentially result in a more precise distal dissection, lower rate of positive circumferential resection margins, and increase the rate of sphincter-sparing procedures. The indications for TaTME are currently expanding, despite not yet being standardized. Training programs are increasing day by day, to improve the learning curve related to this difficult technique. The procedure is feasible and safe with similar intraoperative complications and readmission rates compared with open/laparoscopic approach. Oncological results have shown that TaTME is associated with better quality mesorectal excision and safer distal resection margin. In this work, we review the evolution of TaTME, surgical technique, development, applicability, current situation, and implementation, as well as future perspectives for colorectal cancer and other pathologies. While satisfactory short-term results have been reported, it is a new technique, and long-term results and definitive results from controlled trials are pending. As evidence of safety and feasibility accumulates, training programs structured to standardize teaching, training, and safe expansion will aid the safe spread of TaTME.

Inter-ischial spine distance is a simple index of narrow pelvis that may predict difficulty during laparoscopic low anterior resection: a retrospective study

Background A narrow pelvis makes laparoscopic rectal resection difficult. This study aimed to evaluate whether a simple measurement on computed tomography can predict procedural difficulty. Methods A total of 62 patients with low rectal cancer underwent conventional laparoscopic low anterior resection. The inter-ischial spine (IS) distance (i.e., distance between the ischial spines) was measured on an axial computed tomography slice. Operative time, blood loss, and time from insertion of linear staplers to completion of clamping on the distal end of the rectum (clamp time) were compared. Results Overall, 42 men and 20 women with low rectal cancer were assessed. The mean tumor size was 34.5 mm. Total or tumor-specific mesorectal excisions were performed in all cases; high ligation and resection of the inferior mesenteric arteries were carried out in 92% of patients. The mean operative time, and blood loss were 206 min, and 15 mL respectively. Four patients (6.5%) experienced postoperative complications, including two anastomotic leaks (3.2%). The mean IS distance was 93.3 mm. With simple linear regression, shorter IS distance correlated with longer operative time (R2 = 0.08, P = 0.030) and clamp time (R2 = 0.07, P = 0.046). Using an receiver operating characteristic curve, a narrow pelvis was defined as IS distance < 94.7 mm. Multivariate regression analysis revealed that IS distance < 94.7 mm (odds ratio, 3.51; P = 0.04) was independently associated with a longer clamp time. Conclusions The IS distance is a simple and useful measurement for predicting the difficulty of laparoscopic low anterior resection.